Healthcare Provider Details

I. General information

NPI: 1447736624
Provider Name (Legal Business Name): KENNETH SIMPSON R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HAMPTON VILLAGE PLZ
SAINT LOUIS MO
63109-2127
US

IV. Provider business mailing address

60 HAMPTON VILLAGE PLZ
SAINT LOUIS MO
63109-2127
US

V. Phone/Fax

Practice location:
  • Phone: 314-832-7700
  • Fax: 314-832-7590
Mailing address:
  • Phone: 314-832-7700
  • Fax: 314-832-7590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number030064
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: