Individual
KAYLA REVERMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1350 W US HIGHWAY 50, PHARMACY, O FALLON, IL 62269
(618) 622-0507
Mailing address
1350 W US HIGHWAY 50, PHARMACY, O FALLON, IL 62269
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051298647
IL
183500000X
Pharmacist
2016011547
MO
Other
Enumeration date
10/30/2020
Last updated
10/30/2020
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