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General NPI Number Information
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NPI Number | 1124754098
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Entity Type | Individual
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Provider Name | TRISTEN GEORGE DUNCAN
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Gender | Male
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 401 SUPERCENTER DR
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City | JEFFERSON CITY
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State | MO
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Zip | 65101-8190
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Country | US
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Telephone | 573-635-3877
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Fax | 573-635-6520
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Provider Business Mailing Address
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Address Line | 401 SUPERCENTER DR
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City | JEFFERSON CITY
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State | MO
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Zip | 65101-8190
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Country | US
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Telephone | 573-635-3877
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Fax | 573-635-6520
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2022028381
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License Number State | MO
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