Healthcare Provider Details

I. General information

NPI: 1164368759
Provider Name (Legal Business Name): YINGJIE REN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

3 BON AIRE DR
SAINT LOUIS MO
63132-4302
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-4736
  • Fax:
Mailing address:
  • Phone: 314-257-4736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number2008028414
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: