Healthcare Provider Details

I. General information

NPI: 1053695809
Provider Name (Legal Business Name): MICHAEL GUHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12006 MANCHESTER RD
SAINT LOUIS MO
63131-4415
US

IV. Provider business mailing address

12006 MANCHESTER RD
SAINT LOUIS MO
63131-4415
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-0030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2006028525
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: