Individual
MARK IVANTSOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
860 ARNOLD COMMONS DR, ARNOLD, MO 63010-2164
(636) 282-4817
Mailing address
5918 WOODBROOK DR, SAINT LOUIS, MO 63129-7219
(314) 607-5056
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2022044966
MO
Other
Enumeration date
11/14/2022
Last updated
11/14/2022
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