Healthcare Provider Details

I. General information

NPI: 1487570636
Provider Name (Legal Business Name): JAHARI HINES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3849 VOGEL RD
ARNOLD MO
63010-6201
US

IV. Provider business mailing address

5655 PERSHING AVE APT 431
SAINT LOUIS MO
63112-2146
US

V. Phone/Fax

Practice location:
  • Phone: 636-287-1339
  • Fax:
Mailing address:
  • Phone: 224-475-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2022039935
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: