Active NPI
Jessica Lee Masulla, PHARMD
- Pharmacist
- Lake Saint Louis, MO
National Provider Identifier
1063796753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2009020942
- Practice address
- 101 Civic Center Dr
Lake Saint Louis, MO 63367-3027 - Phone
- (636) 561-3963
- Fax
- (636) 561-5317
- NPI assigned
- Sep 29, 2011
- Last updated
- Nov 30, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051293557 | IL | |
| Pharmacist | 183500000X | 2009020942 | MO | Primary |
Addresses
Primary practice location
101 Civic Center Dr
Lake Saint Louis, MO 63367-3027
Mailing address
101 Civic Center Dr
Lake Saint Louis, MO 63367-3027
Phone (636) 561-3963
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051293557 | IL | MD | Pharmacist |
| 2009020942 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701302400000",
"number": "1063796753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 CIVIC CENTER DR",
"city": "LAKE SAINT LOUIS",
"state": "MO",
"postal_code": "633673027",
"telephone_number": "636-561-3963",
"fax_number": "636-561-5317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 CIVIC CENTER DR",
"city": "LAKE SAINT LOUIS",
"state": "MO",
"postal_code": "633673027",
"telephone_number": "636-561-3963",
"fax_number": "636-561-5317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASULLA",
"first_name": "JESSICA",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-29",
"last_updated": "2023-11-30",
"certification_date": "2023-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051293557",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2009020942",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.