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General NPI Number Information
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NPI Number | 1356551592
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Entity Type | Organization
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Legal Business Name | LETASSY PHARMACY
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 1014 W PINE ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-4840
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Country | US
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Telephone | 573-785-8421
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Fax | 573-785-3348
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Provider Business Mailing Address
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Address Line | 1014 W PINE ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-4840
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Country | US
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Telephone | 573-785-8421
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Fax | 573-785-3348
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Authorized Official
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Title or Position | PHARMACIST
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Name | BERNARD R LETASSY
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Credential | RPH.
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Telephone | 573-785-8421
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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 | 026011
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License Number State | MO
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