Healthcare Provider Details

I. General information

NPI: 1083637581
Provider Name (Legal Business Name): WILLIAM E CLASEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 HOVEN DR
PACIFIC MO
63069-1157
US

IV. Provider business mailing address

12106 TRENTMORE PL
SAINT LOUIS MO
63127-1407
US

V. Phone/Fax

Practice location:
  • Phone: 636-257-4660
  • Fax:
Mailing address:
  • Phone: 314-843-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number027974
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: