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General NPI Number Information
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NPI Number | 1821219072
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Entity Type | Individual
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Provider Name | RALEA BETH DEGRUSON RPH
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 800 S ASH
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City | NEVADA
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State | MO
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Zip | 64772
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Country | US
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Telephone | 417-448-3728
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Fax |
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Provider Business Mailing Address
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Address Line | 28 SE 11TH RD
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City | LAMAR
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State | MO
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Zip | 64759-9201
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Country | US
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Telephone | 417-681-0291
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 43831
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License Number State | MO
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