Provider Demographics
NPI:1972289528
Name:MAYBERRY, MARK STEVEN JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:MAYBERRY
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1590 ARLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1779
Mailing Address - Country:US
Mailing Address - Phone:417-529-1815
Mailing Address - Fax:
Practice Address - Street 1:1605 K66
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4306
Practice Address - Country:US
Practice Address - Phone:620-783-1636
Practice Address - Fax:620-783-1690
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47973183500000X
MO2021009164183500000X
KS1-15280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist