Individual
KODI CAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
2329 W CLAY ST, SAINT CHARLES, MO 63301-2546
(636) 949-6613
Mailing address
2329 W CLAY ST, SAINT CHARLES, MO 63301-2546
(636) 949-6613
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2011027148
MO
Other
Enumeration date
10/25/2011
Last updated
10/25/2011
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