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General NPI Number Information
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NPI Number | 1154427516
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Entity Type | Organization
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Legal Business Name | KREISLER CLNIC PHARMACY
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1602 N. SECOND ST.
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City | CLINTON
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State | MO
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Zip | 64735
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Country | US
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Telephone | 660-885-4646
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 528
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City | CLINTON
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State | MO
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Zip | 64735
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Country | US
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Telephone | 660-885-4646
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MARY D. KLINE-RADFORD
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Credential | RPH
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Telephone | 660-885-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 5423
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License Number State | MO
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