MEDICARE: EVAN J STRAKE PHARM D

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	2019032323	MO

General Provider Information

NPI Number	:	1548818305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN J STRAKE PHARM D

Provider Business Mailing Address
First Line	:	1591 MARY TODD LN
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-6676
Country	:	US
Telephone Number	:	618-660-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	11550 PAGE SERVICE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3509
Country	:	US
Telephone Number	:	314-344-9201
Fax Number	:

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

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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Directions to “ EVAN J STRAKE PHARM D” Practice Location

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