Provider Demographics
NPI:1154744092
Name:WASHINGTON UNIVERSITY ACTU PHARMACY
Entity type:Organization
Organization Name:WASHINGTON UNIVERSITY ACTU PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-747-1915
Mailing Address - Street 1:4570 CHILDRENS PL
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1020
Mailing Address - Country:US
Mailing Address - Phone:314-747-1915
Mailing Address - Fax:314-361-5231
Practice Address - Street 1:4570 CHILDRENS PL
Practice Address - Street 2:SUITE 1200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1020
Practice Address - Country:US
Practice Address - Phone:314-747-1915
Practice Address - Fax:314-361-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0053303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy