Healthcare Provider Details

I. General information

NPI: 1508702648
Provider Name (Legal Business Name): POOJA KALLURI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7422 TOWN SQUARE AVE
O FALLON MO
63368-7013
US

IV. Provider business mailing address

7422 TOWN SQUARE AVE
O FALLON MO
63368-7013
US

V. Phone/Fax

Practice location:
  • Phone: 636-625-5012
  • Fax: 636-625-5015
Mailing address:
  • Phone: 636-625-5012
  • Fax: 636-625-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026017068
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: