Healthcare Provider Details

I. General information

NPI: 1013266345
Provider Name (Legal Business Name): CHELSEA LANDGRAF PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

V. Phone/Fax

Practice location:
  • Phone: 417-576-8877
  • Fax:
Mailing address:
  • Phone: 417-576-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2002029705
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: