Provider Demographics
NPI:1710965504
Name:EASTERLY, BARTON KEENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:BARTON
Middle Name:KEENE
Last Name:EASTERLY
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 1:4758 N PINE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714
Mailing Address - Country:US
Mailing Address - Phone:417-724-8598
Mailing Address - Fax:
Practice Address - Street 1:1328 E EVERGREEN
Practice Address - Street 2:CHRISTIAN HEALTH CARE PHARMACY
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803
Practice Address - Country:US
Practice Address - Phone:417-889-6357
Practice Address - Fax:417-823-3870
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist