MEDICARE: MRS. ELIZABETH NELL SMALL RPH

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	2011005032	MO

General Provider Information

NPI Number	:	1336422641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH NELL SMALL RPH

Provider Business Mailing Address
First Line	:	1349 E REPUBLIC RD
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-7204
Country	:	US
Telephone Number	:	417-877-9451
Fax Number	:

Provider Business Practice Location Address
First Line	:	1349 E REPUBLIC RD
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-7204
Country	:	US
Telephone Number	:	417-877-9451
Fax Number	:

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

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/22/2011

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