Healthcare Provider Details

I. General information

NPI: 1104047869
Provider Name (Legal Business Name): CHAD M MUSSER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 SALT LICK RD
SAINT PETERS MO
63376-5974
US

IV. Provider business mailing address

2000 WILLOWSHADE CT
SAINT PETERS MO
63376-3852
US

V. Phone/Fax

Practice location:
  • Phone: 636-970-3510
  • Fax:
Mailing address:
  • Phone: 636-240-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2005033301
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: