Healthcare Provider Details

I. General information

NPI: 1154819746
Provider Name (Legal Business Name): AMY DAWN BADGLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2018
Last Update Date: 04/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 S MADISON ST
WEBB CITY MO
64870-2834
US

IV. Provider business mailing address

1212 S MADISON ST
WEBB CITY MO
64870-2834
US

V. Phone/Fax

Practice location:
  • Phone: 417-673-5623
  • Fax: 417-673-5409
Mailing address:
  • Phone: 417-673-5623
  • Fax: 417-673-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1999140476
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: