Healthcare Provider Details

I. General information

NPI: 1982990016
Provider Name (Legal Business Name): KIMBERLY REESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 2A
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

665 CLIFDEN DR
WELDON SPRING MO
63304-0510
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2024022588
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH026000
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: