Healthcare Provider Details

I. General information

NPI: 1578921995
Provider Name (Legal Business Name): JAMALEE DAWN HUNTLEY PHARMD, BCPPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-9578
  • Fax: 417-820-4569
Mailing address:
  • Phone: 417-820-9578
  • Fax: 417-820-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2005004195
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number118182
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: