Healthcare Provider Details

I. General information

NPI: 1477244853
Provider Name (Legal Business Name): ADRIANE DANIELLE SEALEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 LOUGHBOROUGH AVE
SAINT LOUIS MO
63111-2621
US

IV. Provider business mailing address

2854 CLEARVIEW DR
SAINT LOUIS MO
63121-4506
US

V. Phone/Fax

Practice location:
  • Phone: 314-752-5272
  • Fax: 314-752-5273
Mailing address:
  • Phone: 314-825-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021029663
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: