MEDICARE: AHMED FETOUH 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	2010003561	MO

General Provider Information

NPI Number	:	1952697518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMED FETOUH PHARM.D.

Provider Business Mailing Address
First Line	:	40 THF BLVD
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1150
Country	:	US
Telephone Number	:	636-536-6215
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 THF BLVD
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1150
Country	:	US
Telephone Number	:	636-536-6215
Fax Number	:

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

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	06/22/2011

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