Healthcare Provider Details

I. General information

NPI: 1265053565
Provider Name (Legal Business Name): BRIAN ZELLERS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MATTHEWS DR
WENTZVILLE MO
63385-4597
US

IV. Provider business mailing address

124 MATTHEWS DR
WENTZVILLE MO
63385-4597
US

V. Phone/Fax

Practice location:
  • Phone: 636-439-9759
  • Fax:
Mailing address:
  • Phone: 636-439-9759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2015005485
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: