Healthcare Provider Details

I. General information

NPI: 1457169302
Provider Name (Legal Business Name): JAMAL NGAWASHON TOURE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BOWLES AVE
FENTON MO
63026-2338
US

IV. Provider business mailing address

1001 BOWLES AVE
FENTON MO
63026-2338
US

V. Phone/Fax

Practice location:
  • Phone: 636-343-0754
  • Fax: 636-343-0697
Mailing address:
  • Phone: 636-343-0754
  • Fax: 636-343-0697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2016029043
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: