Healthcare Provider Details

I. General information

NPI: 1720410731
Provider Name (Legal Business Name): KETA JHALA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4885 MEXICO RD
SAINT PETERS MO
63376-2577
US

IV. Provider business mailing address

4885 MEXICO RD
SAINT PETERS MO
63376-2577
US

V. Phone/Fax

Practice location:
  • Phone: 636-244-5385
  • Fax: 636-244-5386
Mailing address:
  • Phone: 636-244-5385
  • Fax: 636-244-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2013026225
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: