Healthcare Provider Details

I. General information

NPI: 1235730011
Provider Name (Legal Business Name): JEFFREY CARL FRIEDMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 S CAMPBELL AVE
SPRINGFIELD MO
65807-4914
US

IV. Provider business mailing address

2373 S FLORENCE AVE
SPRINGFIELD MO
65807-3017
US

V. Phone/Fax

Practice location:
  • Phone: 417-887-0855
  • Fax:
Mailing address:
  • Phone: 417-631-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2010038519
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: