Healthcare Provider Details

I. General information

NPI: 1023725439
Provider Name (Legal Business Name): KERRI BRYLES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 CLAYTON RD
CLAYTON MO
63117-1103
US

IV. Provider business mailing address

8101 CLAYTON RD
CLAYTON MO
63117-1103
US

V. Phone/Fax

Practice location:
  • Phone: 314-726-2124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2011017095
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: