Healthcare Provider Details

I. General information

NPI: 1700375102
Provider Name (Legal Business Name): ALYSE N BRIGGS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 S KANSAS EXPY STE B
SPRINGFIELD MO
65807-6989
US

IV. Provider business mailing address

3805 S KANSAS EXPY STE B
SPRINGFIELD MO
65807-6989
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-0269
  • Fax:
Mailing address:
  • Phone: 417-269-0269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26027731A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number2020025311
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: