Healthcare Provider Details

I. General information

NPI: 1629017975
Provider Name (Legal Business Name): RICHARD JAMES KOHOUT R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3844 S LINDBERGH BLVD SUITE 150
SUNSET HILLS MO
63127-1368
US

IV. Provider business mailing address

837 WHEELWRIGHT DR
MANCHESTER MO
63021-6658
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-0415
  • Fax: 314-525-0401
Mailing address:
  • Phone: 636-391-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number027499
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: