Healthcare Provider Details

I. General information

NPI: 1912134735
Provider Name (Legal Business Name): WASHINGTON UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6643 SHEPLEY DR HABIF HEALTH AND WELLNESS CENTER
SAINT LOUIS MO
63105-2354
US

IV. Provider business mailing address

1 BROOKINGS DR CB 1201
SAINT LOUIS MO
63130-4862
US

V. Phone/Fax

Practice location:
  • Phone: 314-935-6662
  • Fax: 314-935-8515
Mailing address:
  • Phone: 314-935-6662
  • Fax: 314-935-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number2009009737
License Number StateMO

VIII. Authorized Official

Name: DEBRA HARP
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 314-935-6649