MEDICARE: ALEXANDER J PREWETT 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	2017005790	MO

General Provider Information

NPI Number	:	1215537725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER J PREWETT PHARMD

Provider Business Mailing Address
First Line	:	1157 CHATEAU DR
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-1901
Country	:	US
Telephone Number	:	417-293-3388
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 SPRINGFIELD RD
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-5172
Country	:	US
Telephone Number	:	417-683-4708
Fax Number	:	417-683-6963

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

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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