Healthcare Provider Details

I. General information

NPI: 1477379360
Provider Name (Legal Business Name): MARYEM SHAFIQ YAYA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12266 DE PAUL DR
BRIDGETON MO
63044-2514
US

IV. Provider business mailing address

12266 DE PAUL DR
BRIDGETON MO
63044-2514
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2023050724
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: