MEDICARE: LLOYD WARNER 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	029915	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1164976999	OTHER		CMS

General Provider Information

NPI Number	:	1396461273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLOYD WARNER RPH

Provider Business Mailing Address
First Line	:	1 ALGERNON PL
Second Line	:
City	:	BELLA VISTA
State	:	AR
Zip	:	72715-8474
Country	:	US
Telephone Number	:	660-342-6101
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 E MAIN ST
Second Line	:
City	:	PIERCE CITY
State	:	MO
Zip	:	65723-1228
Country	:	US
Telephone Number	:	417-476-2828
Fax Number	:

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

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	10/13/2022

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Directions to “ LLOYD WARNER RPH” Practice Location

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