Provider Demographics
NPI:1568202356
Name:OZARK MOUNTAIN COMPOUNDING
Entity type:Organization
Organization Name:OZARK MOUNTAIN COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFTIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:417-543-4631
Mailing Address - Street 1:806 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-5532
Mailing Address - Country:US
Mailing Address - Phone:228-222-7169
Mailing Address - Fax:
Practice Address - Street 1:806 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-5532
Practice Address - Country:US
Practice Address - Phone:228-222-7169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy