Provider Demographics
NPI:1740808948
Name:DORN, HALLEY JO (PHARMD)
Entity type:Individual
Prefix:
First Name:HALLEY
Middle Name:JO
Last Name:DORN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 COUNTY ROAD 28
Mailing Address - Street 2:
Mailing Address - City:BOLCKOW
Mailing Address - State:MO
Mailing Address - Zip Code:64427-9658
Mailing Address - Country:US
Mailing Address - Phone:402-440-6589
Mailing Address - Fax:
Practice Address - Street 1:402 E PRICE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:MO
Practice Address - Zip Code:64485-1742
Practice Address - Country:US
Practice Address - Phone:816-324-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020020029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist