Healthcare Provider Details

I. General information

NPI: 1245509991
Provider Name (Legal Business Name): FREDERIC J ZUCCHERO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12647 OLIVE BLVD., SUITE 585 FIRST DATABANK
SAINT LOUIS MO
63141
US

IV. Provider business mailing address

1701 RIDGEMONT CT
SAINT LOUIS MO
63146-2034
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-5125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029923
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: