Active NPI
Thomas Schallom
- Pharmacist
- Washington, MO
National Provider Identifier
1104400647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2018044678
- Practice address
- 1851 Vernaci Dr
Washington, MO 63090-6174 - Phone
- (636) 825-7701
- NPI assigned
- May 11, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2018044678 | MO | Primary |
Addresses
Primary practice location
1851 Vernaci Dr
Washington, MO 63090-6174
Mailing address
4712 Ashwick Ter
Saint Louis, MO 63128-1904
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2018044678 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620691200000",
"number": "1104400647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4712 ASHWICK TER",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631281904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1851 VERNACI DR",
"city": "WASHINGTON",
"state": "MO",
"postal_code": "630906174",
"telephone_number": "636-825-7701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHALLOM",
"first_name": "THOMAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-11",
"last_updated": "2021-05-11",
"certification_date": "2021-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2018044678",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.