Provider Demographics
NPI:1609151018
Name:HARNED, BOOTH KRISTOPHER (RPH)
Entity Type:Individual
Prefix:MR
First Name:BOOTH
Middle Name:KRISTOPHER
Last Name:HARNED
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 1:21400 S BRIAR RD
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-9540
Mailing Address - Country:US
Mailing Address - Phone:816-305-3680
Mailing Address - Fax:
Practice Address - Street 1:909 E REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6004
Practice Address - Country:US
Practice Address - Phone:417-883-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO043188OtherMISSOURI BOARD OF PHARMACY LICENSE NUMBER