Healthcare Provider Details

I. General information

NPI: 1518749134
Provider Name (Legal Business Name): DEBRA JANE CONNER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

2169 N ROCKY TOP RD
BATTLEFIELD MO
65619-8101
US

V. Phone/Fax

Practice location:
  • Phone: 417-496-0405
  • Fax:
Mailing address:
  • Phone: 417-724-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043892
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: