Active NPI
Brandon Glen Eldridge, PHARM.D.
- Pharmacist
- Saint Louis, MO
National Provider Identifier
1124258058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2009020986
- Practice address
- 1504 S Grand Blvd
Saint Louis, MO 63104-1304 - Phone
- (314) 535-3334
- Fax
- (314) 535-3337
- NPI assigned
- Jul 27, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2009020986 | MO | Primary |
| Pharmacist | 183500000X | 051.294668 | IL |
Addresses
Primary practice location
1504 S Grand Blvd
Saint Louis, MO 63104-1304
Mailing address
1504 S Grand Blvd
Saint Louis, MO 63104-1304
Phone (314) 535-3334
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 600447627 | Medicaid | MO |
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 |
|---|---|---|---|
| 051.294668 | IL | MD | Pharmacist |
| 2009020986 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441065600000",
"number": "1124258058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1504 S GRAND BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631041304",
"telephone_number": "314-535-3334",
"fax_number": "314-535-3337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1504 S GRAND BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631041304",
"telephone_number": "314-535-3334",
"fax_number": "314-535-3337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELDRIDGE",
"first_name": "BRANDON",
"middle_name": "GLEN",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-27",
"last_updated": "2015-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2009020986",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.294668",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "600447627",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.