Healthcare Provider Details

I. General information

NPI: 1306066170
Provider Name (Legal Business Name): CHRISTOPHER STEPHEN SHAIN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12647 OLIVE BLVD
SAINT LOUIS MO
63141-6345
US

IV. Provider business mailing address

7908 LYLE LN
DITTMER MO
63023-1513
US

V. Phone/Fax

Practice location:
  • Phone: 314-919-9717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2001001118
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: