Healthcare Provider Details

I. General information

NPI: 1467939454
Provider Name (Legal Business Name): GAY LYNN CUDE PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13025 OLDFARM DR
SAINT LOUIS MO
63146-4360
US

IV. Provider business mailing address

13025 OLDFARM DR
SAINT LOUIS MO
63146-4360
US

V. Phone/Fax

Practice location:
  • Phone: 618-451-0521
  • Fax:
Mailing address:
  • Phone: 314-378-1824
  • Fax: 314-994-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2002027549
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: