Healthcare Provider Details

I. General information

NPI: 1003602822
Provider Name (Legal Business Name): HALEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 DE PAUL DR
BRIDGETON MO
63044-2511
US

IV. Provider business mailing address

9 OAK HILL TER
HERCULANEUM MO
63048-1063
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-9700
  • Fax:
Mailing address:
  • Phone: 636-212-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2025012834
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: