Healthcare Provider Details

I. General information

NPI: 1578034914
Provider Name (Legal Business Name): KACIE M KUEHN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N FRANCISCO AVE
CHICAGO IL
60622-2743
US

IV. Provider business mailing address

3964 LOCKPORT DR
BRIDGETON MO
63044-2100
US

V. Phone/Fax

Practice location:
  • Phone: 314-910-9172
  • Fax:
Mailing address:
  • Phone: 314-910-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number051301768
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: