Provider Demographics
NPI:1851676217
Name:AIL, MARY SUSAN (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:AIL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 HAGEMANN POINTE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-4504
Mailing Address - Country:US
Mailing Address - Phone:314-842-1205
Mailing Address - Fax:
Practice Address - Street 1:1718 CATLIN DR
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-1277
Practice Address - Country:US
Practice Address - Phone:636-461-1347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist