MEDICARE: MISS HALLIE RAE FANNING PHARM. D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	2018024631	MO

General Provider Information

NPI Number	:	1093271843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HALLIE RAE FANNING PHARM. D

Provider Business Mailing Address
First Line	:	2260 HEPPERMAN RD
Second Line	:
City	:	WENTZVILLE
State	:	MO
Zip	:	63385-5314
Country	:	US
Telephone Number	:	573-202-9152
Fax Number	:	636-278-4754

Provider Business Practice Location Address
First Line	:	522 N NEW BALLAS RD STE 206
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6819
Country	:	US
Telephone Number	:	314-499-1227
Fax Number	:	314-499-1228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2019
Last Update Date	:	02/18/2019

Similar Medicare Providers

1609832476 — JASON B AMATO M.D.
Practice Location Address:

522 N NEW BALLAS RD , STE 203
SAINT LOUIS, MO
63141-6819

Practice Phone: 314-569-3323
Practice Fax: 314-569-3358

1285176297 — CHRISTINE DONAHUE DILL FNP-BC
Practice Location Address:

522 N NEW BALLAS RD STE 203
SAINT LOUIS, MO
63141-6819

Practice Phone: 314-569-3323
Practice Fax:

1417589052 — MS. SAMRA FAJIC ACNP
Practice Location Address:

522 N NEW BALLAS RD STE 240
SAINT LOUIS, MO
63141-6819

Practice Phone: 314-567-5100
Practice Fax: 314-567-3387

1174267660 — DR. MARY OLSON PHD
Practice Location Address:

522 N NEW BALLAS RD STE 201
SAINT LOUIS, MO
63141-6819

Practice Phone: 314-833-4210
Practice Fax:

1659073658 — KATHARINE PROPST PA-C
Practice Location Address:

522 N NEW BALLAS RD STE 203
SAINT LOUIS, MO
63141-6819

Practice Phone: 314-569-3323
Practice Fax:

1154893071 — LOCAL HEALTH SPECIALTY
Practice Location Address:

522 N NEW BALLAS RD STE 206
ST. LOUIS, MO
63141-6819

Practice Phone: 314-499-1227
Practice Fax: 314-499-1228

Directions to “ MISS HALLIE RAE FANNING PHARM. D” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.