Provider Demographics
NPI:1437293990
Name:DAUGHERTY, JOSEPH THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 SPUR DR
Mailing Address - Street 2:P.O. BOX 93
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-2311
Mailing Address - Country:US
Mailing Address - Phone:417-468-2530
Mailing Address - Fax:417-859-7116
Practice Address - Street 1:1365 SPUR DR
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2311
Practice Address - Country:US
Practice Address - Phone:417-468-2530
Practice Address - Fax:417-859-7116
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000163543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist