Individual
MICAH BURGDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3920 HAMPTON AVE, SAINT LOUIS, MO 63109-1401
(314) 351-2100
Mailing address
3920 HAMPTON AVE, SAINT LOUIS, MO 63109-1401
(314) 351-2100
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2020038387
MO
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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