Provider Demographics
NPI:1992759922
Name:DARMODY, PAMELA J (R PH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:DARMODY
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 OLD HICKORY CIR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2747
Mailing Address - Country:US
Mailing Address - Phone:636-296-6505
Mailing Address - Fax:
Practice Address - Street 1:3844 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:SUNSET HILLS
Practice Address - State:MO
Practice Address - Zip Code:63127-1368
Practice Address - Country:US
Practice Address - Phone:314-525-0415
Practice Address - Fax:314-525-0401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2003002133OtherSTATE PHARMACY LICENSE NO
MO2003002133OtherSTATE PHARMACY LICENSE NO
1019230001Medicare ID - Type Unspecified