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General NPI Number Information
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NPI Number | 1164704516
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Entity Type | Individual
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Provider Name | HENRY IRVIN PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 610 S 6TH ST
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City | BRANSON
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State | MO
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Zip | 65616-2843
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Country | US
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Telephone | 417-336-9355
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Fax | 417-334-4427
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Provider Business Mailing Address
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Address Line | 250 TEEPEE LANE
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City | KIMBERLING CITY
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State | MO
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Zip | 65686
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Country | US
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Telephone | 417-272-1112
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Fax | 417-272-1118
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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 | 2006038096
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License Number State | MO
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