Healthcare Provider Details

I. General information

NPI: 1457007049
Provider Name (Legal Business Name): SUNEETHA MARE PHD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5819 S LINDBERGH BLVD
SAINT LOUIS MO
63123-6948
US

IV. Provider business mailing address

6 WATERFRONT GRV
SAINT CHARLES MO
63303-4816
US

V. Phone/Fax

Practice location:
  • Phone: 636-373-7966
  • Fax:
Mailing address:
  • Phone: 636-373-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2009003343
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: