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Individual

BOBBY LEAVORN ETCHASON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
R.PH.

Contact information

Practice address
1253 WATER TOWER PL, ARNOLD, MO 63010-2142
(636) 282-0803
Mailing address
4446 KERTH CIRCLE XING, SAINT LOUIS, MO 63128-3131
(314) 892-1792
(636) 282-0816

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
029042
MO
183500000X
Pharmacist
IL

Other

Enumeration date
03/25/2007
Last updated
07/08/2007
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