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General NPI Number Information
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NPI Number | 1639884026
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Entity Type | Individual
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Provider Name | BETH A HAGEDORN BSPHARM
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Gender | Female
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 14805 N OUTER 40 RD STE 140
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City | CHESTERFIELD
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State | MO
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Zip | 63017-6060
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Country | US
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Telephone | 636-733-7333
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Fax |
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Provider Business Mailing Address
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Address Line | 16294 AUTUMN VIEW TERRACE DR
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City | ELLISVILLE
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State | MO
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Zip | 63011-4747
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Country | US
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Telephone | 636-357-3293
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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 | 043130
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License Number State | MO
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