Healthcare Provider Details

I. General information

NPI: 1770853178
Provider Name (Legal Business Name): KELLY STRUEMPH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 3RD ST
BELLEVILLE IL
62220-1915
US

IV. Provider business mailing address

909 LAMI ST D
SAINT LOUIS MO
63104-4214
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-2120
  • Fax:
Mailing address:
  • Phone: 573-680-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.295359
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2011032867
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: