Healthcare Provider Details

I. General information

NPI: 1912957770
Provider Name (Legal Business Name): K THERESE TWOMEY R.PH., J.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: K THERESE SULLIVAN R.PH.,J.D.

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

2174 AVALON RIDGE CIR
FENTON MO
63026-7806
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-9921
  • Fax: 314-454-5399
Mailing address:
  • Phone: 636-861-6069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41391
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: