Walter R Dellenbaugh, RPH
Individual provider Active NPI Pharmacist · Potosi, MO
NPI 1407877145 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1407877145
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 044559 (MO)
- Practice address
- 4 Parkway Shopping Ctr
Potosi, MO 63664-1411 - Phone
- (573) 438-2189
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044559 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 044559 | MO | Yes |
Addresses
Primary practice location
4 Parkway Shopping Ctr
Potosi, MO 63664-1411
Mailing address
1506 Justin LN
Farmington, MO 63640-1436
Phone (573) 760-8934
Other providers in Potosi, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.