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General NPI Number Information
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NPI Number | 1760793608
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Entity Type | Individual
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Provider Name | DAVID M KOMOR RPH
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Gender | Male
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 15446 MANCHESTER RD
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City | ELLISVILLE
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State | MO
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Zip | 63011-3029
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Country | US
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Telephone | 636-227-0830
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 GARDEN VALLEY DR
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City | WILDWOOD
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State | MO
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Zip | 63038-1492
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Country | US
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Telephone |
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Fax |
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 042664
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License Number State | MO
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