Healthcare Provider Details

I. General information

NPI: 1033347828
Provider Name (Legal Business Name): ADVOCATES FOR A HEALTHY COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E TAMPA ST
SPRINGFIELD MO
65806-1131
US

IV. Provider business mailing address

440 E TAMPA ST
SPRINGFIELD MO
65806-1131
US

V. Phone/Fax

Practice location:
  • Phone: 417-831-0150
  • Fax:
Mailing address:
  • Phone: 417-831-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2009017150
License Number StateMO

VIII. Authorized Official

Name: DR. MATTHEW STINSON
Title or Position: CEO
Credential: MD
Phone: 417-831-0150