MEDICARE: MRS. KRISITI L HUESEMAN 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	043637	MO

General Provider Information

NPI Number	:	1740563568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISITI L HUESEMAN RPH

Provider Business Mailing Address
First Line	:	8571 WATSON RD
Second Line	:
City	:	WEBSTER GRVS
State	:	MO
Zip	:	63119-5218
Country	:	US
Telephone Number	:	314-965-5545
Fax Number	:	314-968-1704

Provider Business Practice Location Address
First Line	:	8571 WATSON RD
Second Line	:
City	:	WEBSTER GRVS
State	:	MO
Zip	:	63119-5218
Country	:	US
Telephone Number	:	314-965-5545
Fax Number	:	314-968-1704

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

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	09/28/2011

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