Provider Demographics
NPI:1164704516
Name:IRVIN, HENRY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:IRVIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 TEEPEE LANE
Mailing Address - Street 2:
Mailing Address - City:KIMBERLING CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65686
Mailing Address - Country:US
Mailing Address - Phone:417-272-1112
Mailing Address - Fax:417-272-1118
Practice Address - Street 1:610 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2843
Practice Address - Country:US
Practice Address - Phone:417-336-9355
Practice Address - Fax:417-334-4427
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006038096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist