Provider Demographics
NPI:1821344722
Name:VIRTUE, JUSTIN BRANDON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BRANDON
Last Name:VIRTUE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 W ROBIN ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8091
Mailing Address - Country:US
Mailing Address - Phone:417-576-2777
Mailing Address - Fax:
Practice Address - Street 1:610 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2843
Practice Address - Country:US
Practice Address - Phone:417-576-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012021948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist