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NPI Code Detail

MEDICARE: DR. JOSHUA BOUDEMAN PHARMD

MEDICARE: DR. JOSHUA BOUDEMAN 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
1183500000XPharmacist051.295447IL
2183500000XPharmacistPS60070FL
3183500000XPharmacist2011026558MO

General Provider Information

NPI Number : 1649557661
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSHUA BOUDEMAN PHARMD
Provider Business Mailing Address
First Line : 3527 CHOUTEAU AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63103-2915
Country : US
Telephone Number : 314-771-2900
Fax Number : 317-771-2955
Provider Business Practice Location Address
First Line : 3527 CHOUTEAU AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63103-2915
Country : US
Telephone Number : 314-771-2900
Fax Number : 314-771-2955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2011
Last Update Date : 12/19/2022

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Directions to “ DR. JOSHUA BOUDEMAN PHARMD” Practice Location

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