Healthcare Provider Details

I. General information

NPI: 1164027652
Provider Name (Legal Business Name): CARLOS PARDO-PFEIFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 LOUGHBOROUGH AVE
SAINT LOUIS MO
63111-2621
US

IV. Provider business mailing address

1020 LOUGHBOROUGH AVE
SAINT LOUIS MO
63111-2621
US

V. Phone/Fax

Practice location:
  • Phone: 314-752-5272
  • Fax: 314-752-5273
Mailing address:
  • Phone: 314-752-5272
  • Fax: 314-752-5273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2019035636
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: