Healthcare Provider Details

I. General information

NPI: 1568512986
Provider Name (Legal Business Name): MEDICAL DEVELOPMENTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST
SPRINGFIELD MO
65807-5154
US

IV. Provider business mailing address

1000 E PRIMROSE ST STE 105A
SPRINGFIELD MO
65807-5176
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-5584
  • Fax: 417-269-5582
Mailing address:
  • Phone: 417-269-5584
  • Fax: 417-269-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027295
License Number StateMO

VIII. Authorized Official

Name: JEFF HAWKINS
Title or Position: PRESIDENT
Credential:
Phone: 417-269-6263