Provider Demographics
NPI:1093546780
Name:DALPOAS, DEVIN
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:DALPOAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 N SARAH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2816
Mailing Address - Country:US
Mailing Address - Phone:314-533-1081
Mailing Address - Fax:314-533-1082
Practice Address - Street 1:11 N SARAH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2816
Practice Address - Country:US
Practice Address - Phone:314-533-1081
Practice Address - Fax:314-533-1082
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000169714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist