Provider Demographics
NPI:1124308861
Name:GUTHRIE, SAMUEL TIMOTHY (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:TIMOTHY
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N WESTERN ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-1909
Mailing Address - Country:US
Mailing Address - Phone:573-581-4552
Mailing Address - Fax:
Practice Address - Street 1:101 N WESTERN ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-1905
Practice Address - Country:US
Practice Address - Phone:573-581-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist