Provider Demographics
NPI:1407229164
Name:HAUSEL, MICHAEL GERARD (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GERARD
Last Name:HAUSEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 W ARGONNE DR
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4101
Mailing Address - Country:US
Mailing Address - Phone:314-640-3774
Mailing Address - Fax:
Practice Address - Street 1:329 W ARGONNE DR
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4101
Practice Address - Country:US
Practice Address - Phone:314-640-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO040993OtherPHARMACIST LICENSE