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General NPI Number Information
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NPI Number | 1356612329
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Entity Type | Organization
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Legal Business Name | IDEAL CARE CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 5898 NORTH MAIN SUITE 109
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City | JOPLIN
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State | MO
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Zip | 64801
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Country | US
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Telephone | 417-206-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 5898 NORTH MAIN SUITE 109
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City | JOPLIN
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State | MO
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Zip | 64801
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Country | US
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Telephone | 417-206-2273
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Fax |
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Authorized Official
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Title or Position | PHARMACIST, OWNER
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Name | MRS. LORI BARTLETT
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Credential | RPH
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Telephone | 417-206-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2012000069
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License Number State | MO
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