Healthcare Provider Details

I. General information

NPI: 1952927287
Provider Name (Legal Business Name): SASA DZAFERAGIC PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 DELMAR BLVD
SAINT LOUIS MO
63112-2617
US

IV. Provider business mailing address

7912 SILVER PINE DR
SAINT LOUIS MO
63129-2557
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-7848
  • Fax: 314-367-4849
Mailing address:
  • Phone: 314-368-4794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2003007709
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: