Healthcare Provider Details

I. General information

NPI: 1811330970
Provider Name (Legal Business Name): STEPHANIE TALLON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N HANLEY RD
SAINT LOUIS MO
63134-2700
US

IV. Provider business mailing address

124 OAKSHIRE DR W
GLEN CARBON IL
62034-8541
US

V. Phone/Fax

Practice location:
  • Phone: 866-997-3688
  • Fax:
Mailing address:
  • Phone: 309-370-5320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2012013217
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.291764
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: