Healthcare Provider Details

I. General information

NPI: 1639738438
Provider Name (Legal Business Name): VAN AMBURG & BUSIEK MD'S, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODSMILL ROAD SUITE 330 EAST
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

232 S WOODSMILL ROAD SUITE 330 EAST
CHESTERFIELD MO
63017
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6980
  • Fax: 314-573-2398
Mailing address:
  • Phone: 314-576-2490
  • Fax: 314-576-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA LYNN CRUMP
Title or Position: PHARMACIST IN CHARGE (PIC)
Credential: RPH
Phone: 314-205-6737