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General NPI Number Information
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NPI Number | 1649557661
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Entity Type | Individual
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Provider Name | JOSHUA BOUDEMAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 3527 CHOUTEAU AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63103-2915
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Country | US
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Telephone | 314-771-2900
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Fax | 314-771-2955
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Provider Business Mailing Address
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Address Line | 3527 CHOUTEAU AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63103-2915
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Country | US
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Telephone | 314-771-2900
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Fax | 317-771-2955
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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 | 051.295447
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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 | PS60070
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License Number State | FL
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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 | 2011026558
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License Number State | MO
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