Healthcare Provider Details

I. General information

NPI: 1285273821
Provider Name (Legal Business Name): RELEBOHILE SEKONYELA-RAKOLANYANA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 MID RIVERS MALL DR
SAINT PETERS MO
63376-2113
US

IV. Provider business mailing address

104 LITTLE TREE CT
WENTZVILLE MO
63385-6234
US

V. Phone/Fax

Practice location:
  • Phone: 636-970-2858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.302655
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2019031421
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: