Healthcare Provider Details

I. General information

NPI: 1174032759
Provider Name (Legal Business Name): ERIN WHREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 SPRINGDALE AVE STE A
SAINT LOUIS MO
63134-2400
US

IV. Provider business mailing address

238 VISTAOAK CT
BALLWIN MO
63021-6529
US

V. Phone/Fax

Practice location:
  • Phone: 866-997-3688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2013022802
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: