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General NPI Number Information
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NPI Number | 1043981723
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Entity Type | Individual
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Provider Name | JESSICA PAHNG
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Gender | Female
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 8867 LADUE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-2045
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Country | US
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Telephone | 314-725-7574
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Fax |
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Provider Business Mailing Address
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Address Line | 3939 W PINE BLVD APT 310
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3250
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Country | US
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Telephone | 847-302-7538
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2021033789
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License Number State | MO
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