Provider Demographics
NPI:1033608518
Name:BEISNER, GERALD HOWARD (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:HOWARD
Last Name:BEISNER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3329
Mailing Address - Country:US
Mailing Address - Phone:417-667-2500
Mailing Address - Fax:
Practice Address - Street 1:125 S WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3329
Practice Address - Country:US
Practice Address - Phone:417-667-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170423373336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy