Healthcare Provider Details

I. General information

NPI: 1245905082
Provider Name (Legal Business Name): MICHAEL BURKHART PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5764 S LINDBERGH BLVD
SAINT LOUIS MO
63123-6937
US

IV. Provider business mailing address

5764 S LINDBERGH BLVD
SAINT LOUIS MO
63123-6937
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-3372
  • Fax:
Mailing address:
  • Phone: 314-842-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021032270
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: