| NPI | 1104331610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M DOBBS Manager Of Third Party 314-994-4902 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 163WD0400X Registered Nurse Diabetes Educator |
| 261QM2500X Clinic/Center Medical Specialty | |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2019-01-24 |