Healthcare Provider Details

I. General information

NPI: 1992386551
Provider Name (Legal Business Name): AIDA CRISTINA SCARBOROUGH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12647 OLIVE BLVD STE 600
SAINT LOUIS MO
63141-6346
US

IV. Provider business mailing address

220 W DIEGO PL
CITRUS SPRINGS FL
34434-6187
US

V. Phone/Fax

Practice location:
  • Phone: 800-325-3982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD14423
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS46408
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55892
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: