Healthcare Provider Details

I. General information

NPI: 1114403375
Provider Name (Legal Business Name): JENNIFER LEDNICK RPH
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

3430 S GRAND BLVD
SAINT LOUIS MO
63118-1004
US

IV. Provider business mailing address

3430 S GRAND BLVD
SAINT LOUIS MO
63118-1004
US

V. Phone/Fax

Practice location:
  • Phone: 314-283-7443
  • Fax: 314-865-4897
Mailing address:
  • Phone: 314-772-5722
  • Fax: 314-865-4897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2003023570
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: