Healthcare Provider Details

I. General information

NPI: 1134490261
Provider Name (Legal Business Name): LORI A BUSS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 06/04/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

IV. Provider business mailing address

5141 KENNET DR
COLUMBIA IL
62236-3471
US

V. Phone/Fax

Practice location:
  • Phone: 314-657-9007
  • Fax: 314-206-3604
Mailing address:
  • Phone: 618-920-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number045159
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number45159
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: