MEDICARE: SHEILA NIESE

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	044061	MO

General Provider Information

NPI Number	:	1790125383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA NIESE

Provider Business Mailing Address
First Line	:	11481 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7184
Country	:	US
Telephone Number	:	314-432-5708
Fax Number	:

Provider Business Practice Location Address
First Line	:	11481 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7184
Country	:	US
Telephone Number	:	314-432-5708
Fax Number	:

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

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	06/27/2013

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Directions to “ SHEILA NIESE ” Practice Location

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