Healthcare Provider Details

I. General information

NPI: 1780236877
Provider Name (Legal Business Name): CAILYN NICOLE HOTOP PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9978 KENNERLY RD
SAINT LOUIS MO
63128-2704
US

IV. Provider business mailing address

9978 KENNERLY RD
SAINT LOUIS MO
63128-2704
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-3736
  • Fax: 314-843-3445
Mailing address:
  • Phone: 314-843-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2019026000
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: