MEDICARE: AUDRA CARRIKER PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2013037636	MO

General Provider Information

NPI Number	:	1083203889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDRA CARRIKER PHARM D

Provider Business Mailing Address
First Line	:	712 S MAIN ST
Second Line	:
City	:	BROOKFIELD
State	:	MO
Zip	:	64628-2307
Country	:	US
Telephone Number	:	660-258-2122
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 S MAIN ST
Second Line	:
City	:	BROOKFIELD
State	:	MO
Zip	:	64628-2307
Country	:	US
Telephone Number	:	660-258-2122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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Directions to “ AUDRA CARRIKER PHARM D” Practice Location

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