Individual
DR. CLARK KEBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
4218 LINDELL BLVD, SAINT LOUIS, MO 63108-2916
(314) 534-3829
Mailing address
4588 PARKVIEW PL, SAINT LOUIS, MO 63110-1029
(314) 446-8508
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
015036
KY
183500000X
Pharmacist
Primary
2011021859
MO
Other
Enumeration date
07/19/2010
Last updated
08/10/2011
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