Healthcare Provider Details

I. General information

NPI: 1811180466
Provider Name (Legal Business Name): ST. JOHN'S REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 S FREMONT AVE
SPRINGFIELD MO
65804-2201
US

IV. Provider business mailing address

1965 S FREMONT AVE
SPRINGFIELD MO
65804-2201
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-3577
  • Fax: 417-820-3578
Mailing address:
  • Phone: 417-820-3577
  • Fax: 417-820-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number006618
License Number StateMO

VIII. Authorized Official

Name: ROB SHOCKLEY
Title or Position: RETAIL PHARMACY COORDINATOR
Credential:
Phone: 417-820-6624