Provider Demographics
NPI:1679632285
Name:MYERS, DAN L (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:L
Last Name:MYERS
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:PO BOX 307
Mailing Address - Street 2:N HWY 160
Mailing Address - City:ALTON
Mailing Address - State:MO
Mailing Address - Zip Code:65606-0307
Mailing Address - Country:US
Mailing Address - Phone:417-778-7727
Mailing Address - Fax:417-778-6820
Practice Address - Street 1:N HWY 160
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:MO
Practice Address - Zip Code:65606-0307
Practice Address - Country:US
Practice Address - Phone:417-778-7727
Practice Address - Fax:417-778-6820
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030009840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist