Healthcare Provider Details

I. General information

NPI: 1326047523
Provider Name (Legal Business Name): HEDVA LEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9648 OLIVE BLVD SUITE 309
SAINT LOUIS MO
63132-3002
US

IV. Provider business mailing address

9648 OLIVE BLVD SUITE 309
SAINT LOUIS MO
63132-3002
US

V. Phone/Fax

Practice location:
  • Phone: 314-994-9409
  • Fax:
Mailing address:
  • Phone: 314-994-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044347
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010324
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number044347
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number010324
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: