MEDICARE: J. KEVIN HOWARD B.S. PHARM, R.PH.

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	333600000X	Pharmacy	2019045775	MO
2	3336C0003X	Community/Retail Pharmacy	2019045775	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	043997	OTHER	MO	MISSOURI PHARMACIST PERMIT

General Provider Information

NPI Number	:	1639768336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J. KEVIN HOWARD B.S. PHARM, R.PH.

Provider Business Mailing Address
First Line	:	604A E SOUTH ST
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-8912
Country	:	US
Telephone Number	:	417-581-7777
Fax Number	:	417-581-8152

Provider Business Practice Location Address
First Line	:	604A E SOUTH ST
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-8912
Country	:	US
Telephone Number	:	417-581-7777
Fax Number	:	417-581-8152

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

Provider Enumeration Date	:	01/16/2021
Last Update Date	:	01/16/2021

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