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General NPI Number Information
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NPI Number | 1982822573
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Entity Type | Individual
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Provider Name | PAUL JUANG PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 02/25/2017
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Provider Practice Location Address
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Address Line | 216 S KINGSHIGHWAY BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1026
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Country | US
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Telephone | 314-504-7104
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 BLUE JAY CV
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City | BRENTWOOD
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State | MO
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Zip | 63144-1604
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 2005031088
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License Number State | MO
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