Healthcare Provider Details

I. General information

NPI: 1982987210
Provider Name (Legal Business Name): KRIS HUTCHINGS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3497 TECHNOLOGY DR
LAKE ST LOUIS MO
63367-2599
US

IV. Provider business mailing address

3497 TECHNOLOGY DR
LAKE ST LOUIS MO
63367-2599
US

V. Phone/Fax

Practice location:
  • Phone: 636-625-0691
  • Fax: 636-625-0694
Mailing address:
  • Phone: 636-625-0691
  • Fax: 636-625-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044195
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: