Active NPI
Danielle R Fairbanks
- Pharmacist
- Hollister, MO
National Provider Identifier
1972006310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2019044157
- Practice address
- 101 Industrial Park Drive
Hollister, MO 65672 - Phone
- (417) 336-6901
- NPI assigned
- Mar 12, 2018
- Last updated
- Dec 17, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 22336 | IA | |
| Pharmacist | 183500000X | 14591 | NE | |
| Pharmacist | 183500000X | 2019044157 | MO | Primary |
Addresses
Primary practice location
101 Industrial Park Drive
Hollister, MO 65672
Mailing address
163 Osprey Lane
Blue Eye, MO 65611
Phone (402) 995-9506
Other names 1
- Danielle R Fairbanks
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14591 | NE | MD | Mental Health Counselor |
| 22336 | IA | MD | Pharmacist |
| 2019044157 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
101 Industrial Park Dr
Hollister, MO 65672
Phone (417) 336-6901
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671235200000",
"number": "1972006310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "163 OSPREY LANE",
"city": "BLUE EYE",
"state": "MO",
"postal_code": "65611",
"telephone_number": "402-995-9506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 INDUSTRIAL PARK DRIVE",
"city": "HOLLISTER",
"state": "MO",
"postal_code": "65672",
"telephone_number": "417-336-6901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRBANKS",
"first_name": "DANIELLE",
"middle_name": "R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-12",
"last_updated": "2022-12-17",
"certification_date": "2022-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "22336",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NE",
"license": "14591",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2019044157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DANIELLE",
"last_name": "FAIRBANKS",
"middle_name": "R",
"credential": "PHARMD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Hollister, MO
- Brocklyn N Carson, OT
- Community Christian Counseling
- Christina Milynnne Cory
- Judith Jean Crites-Lutz, L.P.C.
- Elysian Medical Center 1 - Hollister LLC
- Family Pharmacy of Missouri LLC (Family Pharmacy #7)
- Family Pharmacy Partnership
- Forefront Dermatology, S.C. (Swann Dermatology Partners, A Forefront Dermatology Practice)
- Victor Alexander Garcia, PHARMD
- Andrew Jester, LMT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.