Individual
MRS. SUSAN WILLIS PHARISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
419 COUNTRY OAK DR, CHESTERFIELD, MO 63017-2821
(314) 469-6275
Mailing address
419 COUNTRY OAK DR, CHESTERFIELD, MO 63017-2821
(314) 469-6275
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
20000174933
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
710000796
RAILROAD CPIN
MO
Enumeration date
08/27/2008
Last updated
08/27/2008
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