Healthcare Provider Details

I. General information

NPI: 1497417620
Provider Name (Legal Business Name): ADAM ARNOLD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11560 OLIVE BLVD
SAINT LOUIS MO
63141-7111
US

IV. Provider business mailing address

11560 OLIVE BLVD
SAINT LOUIS MO
63141-7111
US

V. Phone/Fax

Practice location:
  • Phone: 314-995-7128
  • Fax: 314-995-7149
Mailing address:
  • Phone: 314-995-7128
  • Fax: 314-995-7149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2016001164
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: