Provider Demographics
NPI:1972304525
Name:ROUGHTON, BART A (PHARMACIST)
Entity type:Individual
Prefix:
First Name:BART
Middle Name:A
Last Name:ROUGHTON
Suffix:
Gender:
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 W AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-2805
Mailing Address - Country:US
Mailing Address - Phone:417-667-3953
Mailing Address - Fax:417-667-3953
Practice Address - Street 1:1407 W AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-2805
Practice Address - Country:US
Practice Address - Phone:417-667-3953
Practice Address - Fax:417-667-3953
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist