Healthcare Provider Details

I. General information

NPI: 1235040916
Provider Name (Legal Business Name): SUEJLA PASIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 WILLIAM ST
CAPE GIRARDEAU MO
63703-5817
US

IV. Provider business mailing address

5547 BELLEMEADE TRAIL CT
SAINT LOUIS MO
63129-2377
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-5264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021039633
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: