Healthcare Provider Details

I. General information

NPI: 1538442652
Provider Name (Legal Business Name): MCKENNA ANN MEZERA PHARM D, BCSCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CLAYTON RD 3RD FLOOR
ST LOUIS MO
63117
US

IV. Provider business mailing address

6400 CLAYTON RD 3RD FLOOR PHARMACY
SAINT LOUIS MO
63117
US

V. Phone/Fax

Practice location:
  • Phone: 314-925-4735
  • Fax:
Mailing address:
  • Phone: 314-925-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2009016883
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License NumberB12101664
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: