Healthcare Provider Details

I. General information

NPI: 1801607775
Provider Name (Legal Business Name): TALIESHA HART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 LINDELL BLVD
SAINT LOUIS MO
63108-2916
US

IV. Provider business mailing address

768 BUCKNER RD
WENTZVILLE MO
63385-5408
US

V. Phone/Fax

Practice location:
  • Phone: 314-371-4286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2024042851
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: