MEDICARE: DR. MICHELLE BOECKMANN

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	2018039375	MO

General Provider Information

NPI Number	:	1407458987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE BOECKMANN

Provider Business Mailing Address
First Line	:	601 APPLEWOOD DR
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-2501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 S KIRKWOOD RD
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-7224
Country	:	US
Telephone Number	:	314-835-9409
Fax Number	:

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

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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Directions to “ DR. MICHELLE BOECKMANN ” Practice Location

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