MEDICARE: CHRISTINE M KOHLER RPH

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	41742	MO

General Provider Information

NPI Number	:	1639453384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE M KOHLER RPH

Provider Business Mailing Address
First Line	:	4925 SOUTHWEST AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-3425
Country	:	US
Telephone Number	:	314-773-5818
Fax Number	:	314-773-1434

Provider Business Practice Location Address
First Line	:	4925 SOUTHWEST AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-3425
Country	:	US
Telephone Number	:	314-773-5818
Fax Number	:	314-773-1434

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

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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