Provider Demographics
NPI:1235702291
Name:ARMENTROUT, PEGGY MOSER (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:MOSER
Last Name:ARMENTROUT
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1658
Mailing Address - Country:US
Mailing Address - Phone:660-882-5208
Mailing Address - Fax:660-882-8125
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1658
Practice Address - Country:US
Practice Address - Phone:660-882-5208
Practice Address - Fax:660-882-8125
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist