Healthcare Provider Details

I. General information

NPI: 1952091787
Provider Name (Legal Business Name): JOSHUA BEANE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11253 SAINT CHARLES ROCK RD
BRIDGETON MO
63044-2702
US

IV. Provider business mailing address

155 BON AIRE DR
FLORISSANT MO
63033-6336
US

V. Phone/Fax

Practice location:
  • Phone: 314-738-0235
  • Fax:
Mailing address:
  • Phone: 314-488-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2023010506
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: