Provider Demographics
NPI:1881659126
Name:BARTMESS, GARRY BRECK (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARRY
Middle Name:BRECK
Last Name:BARTMESS
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 1:1701 BIG BEND RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2916
Mailing Address - Country:US
Mailing Address - Phone:573-718-8728
Mailing Address - Fax:
Practice Address - Street 1:190 EAST RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:PUXICO
Practice Address - State:MO
Practice Address - Zip Code:63960
Practice Address - Country:US
Practice Address - Phone:573-222-6206
Practice Address - Fax:573-222-6406
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist