MEDICARE: STACY L SCATCHERD BS IN PHARMACY

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	183500000X	Pharmacist	2002022593	MO

General Provider Information

NPI Number	:	1235427576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY L SCATCHERD BS IN PHARMACY

Provider Business Mailing Address
First Line	:	4500 RUSTY RD.
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63128
Country	:	US
Telephone Number	:	314-894-7952
Fax Number	:	314-894-7973

Provider Business Practice Location Address
First Line	:	4200 RUSTY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-1973
Country	:	US
Telephone Number	:	314-894-7952
Fax Number	:	314-894-7973

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

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	07/20/2011

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