Healthcare Provider Details

I. General information

NPI: 1982978284
Provider Name (Legal Business Name): ALEX VAYMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106B FOUR SEASONS SHOPPING CENTER
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

106B FOUR SEASONS SHOPPING CENTER
CHESTERFIELD MO
63017
US

V. Phone/Fax

Practice location:
  • Phone: 314-469-7171
  • Fax: 314-469-1010
Mailing address:
  • Phone: 314-469-7171
  • Fax: 314-469-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044835
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: