Provider Demographics
NPI:1639768336
Name:HOWARD, J. KEVIN (BS PHARM, RPH)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:KEVIN
Last Name:HOWARD
Suffix:
Gender:M
Credentials:BS PHARM, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604A E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8912
Mailing Address - Country:US
Mailing Address - Phone:417-581-7777
Mailing Address - Fax:417-581-8152
Practice Address - Street 1:604A E SOUTH ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8912
Practice Address - Country:US
Practice Address - Phone:417-581-7777
Practice Address - Fax:417-581-8152
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019045775333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO043997OtherMISSOURI PHARMACIST PERMIT