Healthcare Provider Details

I. General information

NPI: 1437149382
Provider Name (Legal Business Name): MARK STEVEN LAUER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12120 CONWAY RD
SAINT LOUIS MO
63141-8213
US

IV. Provider business mailing address

4 PEBBLE ACRES CT
HIGH RIDGE MO
63049-1665
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7843
  • Fax: 314-251-5873
Mailing address:
  • Phone: 636-677-0448
  • Fax: 314-251-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040178
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: