Hermitage Professional Enterprises Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

004831 Issued in MO

Legal business name

HERMITAGE PROFESSIONAL ENTERPRISES INC

Doing business as

Hermitage Professional Pharmacy

Practice address

23649 Dallas St
Hermitage, MO 65668-9231

Phone

(417) 745-2136

Fax

(417) 745-2130

NPI assigned

Sep 26, 2006

Last updated

Sep 19, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Al Nyberg

Title

President

Phone

(417) 745-2136

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• HERMITAGE PROFESSIONAL PHARMACY Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alvin Nyberg, RPH

  • Pharmacist
  • Buffalo, MO
  • NPI 1558800888
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1528169083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "HERMITAGE",
            "state": "MO",
            "postal_code": "65668",
            "telephone_number": "417-745-2136",
            "fax_number": "417-745-2130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23649 DALLAS ST",
            "city": "HERMITAGE",
            "state": "MO",
            "postal_code": "656689231",
            "telephone_number": "417-745-2136",
            "fax_number": "417-745-2130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERMITAGE PROFESSIONAL ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2025-09-19",
        "certification_date": "2021-11-24",
        "status": "A",
        "authorized_official_last_name": "NYBERG",
        "authorized_official_first_name": "AL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "417-745-2136"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "004831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2050737",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "602206906",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HERMITAGE PROFESSIONAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HERMITAGE PROFESSIONAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Derrick Bennet Eichstadt, D.C.
• Dalsia Farrow
• Amy M Greenspan, D.D.S.
• Angela Kay Greer
• Lori Hays, LPN/BIRTH DOULA
• Hickory County Health Department
• James C. Fusco, D.D.S., P.C. (Hermitage Dental Cener)
• Scott Alan Mackey, LMSW
• Joy Sara Murphy, LPC
• N & R of Hermitage LLC (Hermitage Nursing & Rehab)

• Community/Retail Pharmacy in Hermitage, MO
• Providers in Hermitage, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.