Healthcare Provider Details

I. General information

NPI: 1164735916
Provider Name (Legal Business Name): DANIELLE D SKOUBY PHARM.D., BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

50 SCENIC COVE LN
SAINT CHARLES MO
63303-6595
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone: 314-484-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2010025190
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: