Healthcare Provider Details

I. General information

NPI: 1225616469
Provider Name (Legal Business Name): WASHINGTON UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S TAYLOR AVE RM 202
SAINT LOUIS MO
63110-1035
US

IV. Provider business mailing address

4523 CLAYTON AVENUE CAMPUS BOX 8051
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-273-4246
  • Fax:
Mailing address:
  • Phone: 314-273-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CATHY EGHIGIAN
Title or Position: DIRECTOR, MANAGED CARE
Credential:
Phone: 314-273-0770