Healthcare Provider Details

I. General information

NPI: 1013290113
Provider Name (Legal Business Name): CHESTER J DUCHNOWSKI JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2011
Last Update Date: 09/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 WOLFRUM RD
WELDON SPRING MO
63304-7625
US

IV. Provider business mailing address

1003 WOLFRUM RD
WELDON SPRING MO
63304-7625
US

V. Phone/Fax

Practice location:
  • Phone: 636-300-0158
  • Fax:
Mailing address:
  • Phone: 636-300-0158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040147
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: