Provider Demographics
NPI:1194318964
Name:MONTERO, NICHOLAS MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:MONTERO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 GRAVOIS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3687
Mailing Address - Country:US
Mailing Address - Phone:314-842-0910
Mailing Address - Fax:314-842-7982
Practice Address - Street 1:11330 GRAVOIS RD STE 202
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3687
Practice Address - Country:US
Practice Address - Phone:314-842-0910
Practice Address - Fax:314-842-7982
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016032035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist