Healthcare Provider Details

I. General information

NPI: 1841676012
Provider Name (Legal Business Name): AMY PEARCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 W SUNSET ST
SPRINGFIELD MO
65807-6040
US

IV. Provider business mailing address

2240 W SUNSET ST
SPRINGFIELD MO
65807-6040
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-4663
  • Fax:
Mailing address:
  • Phone: 417-269-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2015031926
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16184
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: