Healthcare Provider Details

I. General information

NPI: 1922584044
Provider Name (Legal Business Name): STEPHANIE DANIELLE HULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 ARSENAL ST
SAINT LOUIS MO
63139-1011
US

IV. Provider business mailing address

135 S LAWN AVE
O FALLON IL
62269-1905
US

V. Phone/Fax

Practice location:
  • Phone: 314-771-5314
  • Fax:
Mailing address:
  • Phone: 618-580-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051298132
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2014026379
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: