Healthcare Provider Details

I. General information

NPI: 1023309978
Provider Name (Legal Business Name): SANDRA I ZUCCARELLO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDY I ZUCCARELLO PHARMD

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-6439
  • Fax:
Mailing address:
  • Phone: 314-289-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21220
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: