Basic Information
| Provider Information | |||||||||
| NPI: | 1558795864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOOLEY | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 S FLINT AVE | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656132158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177774517 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1820 S SPRINGFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656132563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177773700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2013 | ||||||||
| LastUpdateDate: | 08/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 051296687 | IL | N | Pharmacy Service Providers | Pharmacist | 183500000X | 2013029810 | MO | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.