MEDICARE: DR. CHAD M MUSSER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2005033301	MO

General Provider Information

NPI Number	:	1104047869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD M MUSSER PHARMD

Provider Business Mailing Address
First Line	:	2000 WILLOWSHADE CT
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-3852
Country	:	US
Telephone Number	:	636-240-0439
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 SALT LICK RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-5974
Country	:	US
Telephone Number	:	636-970-3510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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