Provider Demographics
NPI:1689951048
Name:HAUCK, BARBARA JEAN (R PH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:HAUCK
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 N BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2350
Mailing Address - Country:US
Mailing Address - Phone:573-592-7030
Mailing Address - Fax:573-592-7399
Practice Address - Street 1:1410 N BLUFF ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2350
Practice Address - Country:US
Practice Address - Phone:573-592-7030
Practice Address - Fax:573-592-7399
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO41238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist