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General NPI Number Information
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NPI Number | 1154744092
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Entity Type | Organization
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Legal Business Name | WASHINGTON UNIVERSITY ACTU PHARMACY
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 4570 CHILDRENS PL SUITE 1200
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1020
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Country | US
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Telephone | 314-747-1915
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Fax | 314-361-5231
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Provider Business Mailing Address
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Address Line | 4570 CHILDRENS PL SUITE 1200
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1020
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Country | US
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Telephone | 314-747-1915
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Fax | 314-361-5231
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. MICHAEL C ROYAL
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Credential | R.PH.
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Telephone | 314-747-1915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 005330
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License Number State | MO
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