=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396461273
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LLOYD WARNER RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2022
-----------------------------------------------------
Last Update Date | 10/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 E MAIN ST
-----------------------------------------------------
City | PIERCE CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65723-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-476-2828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 ALGERNON PL
-----------------------------------------------------
City | BELLA VISTA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72715-8474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-342-6101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 029915
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------