Healthcare Provider Details

I. General information

NPI: 1396321592
Provider Name (Legal Business Name): AMY JOSEPHINE ENSLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY JOSEPHINE HARVEY

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 W SUNSHINE ST
SPRINGFIELD MO
65807-0906
US

IV. Provider business mailing address

605 N 7TH AVE
OZARK MO
65721-9320
US

V. Phone/Fax

Practice location:
  • Phone: 417-862-7447
  • Fax:
Mailing address:
  • Phone: 903-413-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2017005782
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: