Healthcare Provider Details

I. General information

NPI: 1124961529
Provider Name (Legal Business Name): ERICA KATE MARTIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA KATE FIETH PHARMD

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ENTRANCE WAY
SAINT PETERS MO
63376-1645
US

IV. Provider business mailing address

150 ENTRANCE WAY
SAINT PETERS MO
63376-1645
US

V. Phone/Fax

Practice location:
  • Phone: 314-657-9015
  • Fax: 636-916-7156
Mailing address:
  • Phone: 314-657-9015
  • Fax: 636-916-7156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2022023812
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: