Provider Demographics
NPI:1083963177
Name:SAHLFELD, JESSE O (BS PHARM)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:O
Last Name:SAHLFELD
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S. OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301
Mailing Address - Country:US
Mailing Address - Phone:660-826-0462
Mailing Address - Fax:660-826-5697
Practice Address - Street 1:300 S. OHIO AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301
Practice Address - Country:US
Practice Address - Phone:660-826-0462
Practice Address - Fax:660-826-5697
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPH042769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist