Healthcare Provider Details

I. General information

NPI: 1629352471
Provider Name (Legal Business Name): LAURA KARGACIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 HUNTER LN
BYRNES MILL MO
63051-2042
US

IV. Provider business mailing address

4535 HUNTER LN
BYRNES MILL MO
63051-2042
US

V. Phone/Fax

Practice location:
  • Phone: 636-375-3656
  • Fax: 636-375-3647
Mailing address:
  • Phone: 636-375-3656
  • Fax: 636-375-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042300
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: