MEDICARE: PAMELA JEAN HEILWAGNER 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	042437	MO

General Provider Information

NPI Number	:	1891079935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA JEAN HEILWAGNER RPH.

Provider Business Mailing Address
First Line	:	9978 KENNERLY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2704
Country	:	US
Telephone Number	:	314-843-3736
Fax Number	:	314-843-3445

Provider Business Practice Location Address
First Line	:	9978 KENNERLY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2704
Country	:	US
Telephone Number	:	314-843-3736
Fax Number	:	314-843-3445

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

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	05/17/2026

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