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General NPI Number Information
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NPI Number | 1528610946
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Entity Type | Individual
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Provider Name | KORINNE ELIZABETH SACKETT PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 2020 ROCK RD
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City | DE SOTO
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State | MO
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Zip | 63020-1052
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Country | US
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Telephone | 636-586-1766
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Fax |
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Provider Business Mailing Address
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Address Line | 2393 RIDGECREST DR
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City | ARNOLD
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State | MO
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Zip | 63010-2266
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Country | US
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Telephone |
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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 | 2017007488
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License Number State | MO
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