Kory Aaron Charpentier, PHARM. D.
Individual provider Active NPI Pharmacist · Ava, MO
NPI 1922519909 · NPPES record last updated Oct 18, 2017
Key facts
- NPI
- 1922519909
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2017023714 (MO)
- Practice address
- 1309 NW 12TH Ave
Ava, MO 65608 - Phone
- (417) 683-4708
- NPI assigned
- Oct 18, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017023714 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East, LP | Past | Accepting new patients | |
| Wal-Mart Stores East LP | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2017023714 | MO | Yes |
Addresses
Primary practice location
1309 NW 12TH Ave
Ava, MO 65608
Mailing address
1309 NW 12TH Ave
Ava, MO 65608
Phone (417) 683-4708
Other providers in Ava, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2017. 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.