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General NPI Number Information
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NPI Number | 1962830588
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Entity Type | Individual
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Provider Name | KERI HENRY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 11134 LINDBERGH BUSINESS CT SUITE D
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City | SAINT LOUIS
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State | MO
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Zip | 63123-7838
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Country | US
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Telephone | 618-780-3116
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Fax |
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Provider Business Mailing Address
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Address Line | 1216 SHADOW RIDGE XING
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City | O FALLON
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State | IL
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Zip | 62269-3117
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Country | US
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Telephone | 618-780-3116
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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 | 051292685
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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 | 2012036676
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License Number State | MO
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