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General NPI Number Information
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NPI Number | 1538788914
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Entity Type | Individual
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Provider Name | JENNIFER TUSSEY PHARM.D., AAHIVP
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Gender | Female
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 1234 S KINGSHIGHWAY BLVD STE 1900
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2182
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Country | US
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Telephone | 314-657-9012
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 S KINGSHIGHWAY BLVD STE 1900
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2182
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Country | US
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Telephone | 314-657-9012
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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 | 051301073
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03438383
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2016019831
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License Number State | MO
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