Individual
AVERY HAGEDORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
301 HIGHLANDS BOULEVARD DR, MANCHESTER, MO 63011-4385
(636) 868-7406
Mailing address
48 BERKSHIRE DR, RICHMOND HEIGHTS, MO 63117-1046
(314) 243-7809
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2010037351
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2010037351
MISSOURI BOARD OF PHARMACY
MO
Enumeration date
04/08/2021
Last updated
04/08/2021
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