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NPI Code Detail

MEDICARE: RILEY MARIE KRUS

MEDICARE: RILEY MARIE KRUS
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
1183500000XPharmacist2015029223MO

General Provider Information

NPI Number : 1629679204
Entity Type Code : Individual
Provider Name (Legal Business Name) : RILEY MARIE KRUS
Provider Business Mailing Address
First Line : 9541 LODGE POLE LN
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63126-2123
Country : US
Telephone Number : 314-605-8416
Fax Number :
Provider Business Practice Location Address
First Line : 1900 MAPLEWOOD COMMONS DR
Second Line :
City : MAPLEWOOD
State : MO
Zip : 63143-1005
Country : US
Telephone Number : 314-781-2935
Fax Number : 314-781-3254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2020
Last Update Date : 11/02/2020

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