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General NPI Number Information
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NPI Number | 1144910167
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Entity Type | Individual
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Provider Name | MIRIAM BISADA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 13144 ROYAL PINES DR
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City | SAINT LOUIS
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State | MO
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Zip | 63146-2251
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Country | US
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Telephone | 314-680-2571
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Fax |
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Provider Business Mailing Address
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Address Line | 10650 OLIVE BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7834
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Country | US
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Telephone | 314-680-2571
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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 | 2023006512
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License Number State | MO
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