Healthcare Provider Details

I. General information

NPI: 1821693268
Provider Name (Legal Business Name): LINDSAY MERRYFIELD REAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 09/25/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W BENTON ST
WINDSOR MO
65360-1102
US

IV. Provider business mailing address

200 W BENTON ST
WINDSOR MO
65360-1102
US

V. Phone/Fax

Practice location:
  • Phone: 660-647-2134
  • Fax: 660-647-2653
Mailing address:
  • Phone: 660-647-2134
  • Fax: 660-647-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2005033289
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: