Healthcare Provider Details

I. General information

NPI: 1790254647
Provider Name (Legal Business Name): MEDS TO LIVE BY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N. SCARLETT WAY
SPRINGFIELD MO
65802
US

IV. Provider business mailing address

1134 N. SCARLETT WAY
SPRINGFIELD MO
65802
US

V. Phone/Fax

Practice location:
  • Phone: 417-861-1800
  • Fax: 417-771-5470
Mailing address:
  • Phone: 417-861-1800
  • Fax: 417-771-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANY CHAWNTAY CORYELL
Title or Position: PHARMACIST
Credential: RPH
Phone: 417-861-1800