Individual
DR. CLINTON BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
4250 RUSTY RD, T1509, SAINT LOUIS, MO 63128-1973
(314) 892-6428
Mailing address
4250 RUSTY RD, T1509, SAINT LOUIS, MO 63128-1973
(314) 892-6428
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2010031677
MO
Other
Enumeration date
06/14/2011
Last updated
06/14/2011
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