Healthcare Provider Details

I. General information

NPI: 1124630876
Provider Name (Legal Business Name): KAREN CHIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2020
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date: 07/12/2023
Reactivation Date: 08/11/2023

III. Provider practice location address

4218 LINDELL BLVD
SAINT LOUIS MO
63108-2916
US

IV. Provider business mailing address

3204 PEACH ORCHARD RD
AUGUSTA GA
30906-4862
US

V. Phone/Fax

Practice location:
  • Phone: 314-371-4286
  • Fax: 314-371-4749
Mailing address:
  • Phone: 706-796-7240
  • Fax: 706-619-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH031088
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2022041301
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: