Provider Demographics
NPI:1972103927
Name:PILCHER, KERI LYNN
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LYNN
Last Name:PILCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19403 S 1150 RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-6190
Mailing Address - Country:US
Mailing Address - Phone:417-684-2993
Mailing Address - Fax:
Practice Address - Street 1:2250E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-4258
Practice Address - Country:US
Practice Address - Phone:417-667-3011
Practice Address - Fax:417-667-3055
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist