Provider Demographics
NPI:1285919431
Name:CRONISTER, AARON J (RPH)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:J
Last Name:CRONISTER
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 1:2623 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-3300
Mailing Address - Country:US
Mailing Address - Phone:417-624-1111
Mailing Address - Fax:417-624-9094
Practice Address - Street 1:2623 W 7TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3300
Practice Address - Country:US
Practice Address - Phone:417-624-1111
Practice Address - Fax:417-624-9094
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11946183500000X
MO044699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist