Healthcare Provider Details

I. General information

NPI: 1013534601
Provider Name (Legal Business Name): KATELYN NICOLE TOENISKOETTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

7779 WEAVER AVE
MAPLEWOOD MO
63143-1107
US

V. Phone/Fax

Practice location:
  • Phone: 176-632-4254
  • Fax:
Mailing address:
  • Phone: 618-207-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2017024218
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPH240710
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: