MEDICARE: COLBY GROVE PHARMD

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	2012029728	MO

General Provider Information

NPI Number	:	1124752563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLBY GROVE PHARMD

Provider Business Mailing Address
First Line	:	5492 HIGHWAY H UNIT E
Second Line	:
City	:	PLEASANT HOPE
State	:	MO
Zip	:	65725-8227
Country	:	US
Telephone Number	:	417-840-6912
Fax Number	:

Provider Business Practice Location Address
First Line	:	5492 HIGHWAY H UNIT E
Second Line	:
City	:	PLEASANT HOPE
State	:	MO
Zip	:	65725-8227
Country	:	US
Telephone Number	:	417-840-6912
Fax Number	:

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

Provider Enumeration Date	:	07/12/2022
Last Update Date	:	07/12/2022

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Directions to “ COLBY GROVE PHARMD” Practice Location

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