Healthcare Provider Details

I. General information

NPI: 1760254247
Provider Name (Legal Business Name): CHANTEL HARDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 SAINT CHARLES ROCK RD
SAINT LOUIS MO
63114-4246
US

IV. Provider business mailing address

9070 SAINT CHARLES ROCK RD
SAINT LOUIS MO
63114-4246
US

V. Phone/Fax

Practice location:
  • Phone: 314-733-0607
  • Fax:
Mailing address:
  • Phone: 314-733-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2023042714
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: