Healthcare Provider Details

I. General information

NPI: 1790261675
Provider Name (Legal Business Name): TALIS NGUYEN-BRICS PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 UNION BLVD
SAINT LOUIS MO
63115-1142
US

IV. Provider business mailing address

3431 UNION BLVD
SAINT LOUIS MO
63115-1142
US

V. Phone/Fax

Practice location:
  • Phone: 314-381-3007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2017029292
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: