Healthcare Provider Details

I. General information

NPI: 1942805932
Provider Name (Legal Business Name): ANTON KALNA III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S TRUMAN BLVD
CRYSTAL CITY MO
63019-1726
US

IV. Provider business mailing address

1956 CASA DR
ARNOLD MO
63010-1278
US

V. Phone/Fax

Practice location:
  • Phone: 636-937-3178
  • Fax:
Mailing address:
  • Phone: 636-577-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2013026476
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: