Healthcare Provider Details

I. General information

NPI: 1447912985
Provider Name (Legal Business Name): SAMER FARES ISSA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 LINDELL BLVD
SAINT LOUIS MO
63108-2916
US

IV. Provider business mailing address

1727 COACHWAY LN
HAZELWOOD MO
63042-1379
US

V. Phone/Fax

Practice location:
  • Phone: 314-371-4286
  • Fax:
Mailing address:
  • Phone: 314-281-3583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021035903
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: