Healthcare Provider Details

I. General information

NPI: 1710983168
Provider Name (Legal Business Name): AMY CAROLE DEWEIN R.PH., PHARM.D, MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SOMERSET DOWNS
SAINT LOUIS MO
63124-1007
US

IV. Provider business mailing address

25 SOMERSET DOWNS
SAINT LOUIS MO
63124-1007
US

V. Phone/Fax

Practice location:
  • Phone: 314-308-0911
  • Fax:
Mailing address:
  • Phone: 314-308-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-040259
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17353
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2005003710
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: