Active NPI
Andrew Wayne Stine
- Pharmacist
- Lake Saint Louis, MO
National Provider Identifier
1134720675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 043655
- Practice address
- 6100 Ronald Reagan Dr
Lake Saint Louis, MO 63367-2660 - Phone
- (479) 420-1320
- NPI assigned
- Nov 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 043655 | MO | Primary |
Addresses
Primary practice location
6100 Ronald Reagan Dr
Lake Saint Louis, MO 63367-2660
Mailing address
1402 Homestead Valley Dr
Wildwood, MO 63005-8446
Phone (636) 328-5887
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 |
|---|---|---|---|
| 043655 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604275200000",
"number": "1134720675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1402 HOMESTEAD VALLEY DR",
"city": "WILDWOOD",
"state": "MO",
"postal_code": "630058446",
"telephone_number": "636-328-5887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6100 RONALD REAGAN DR",
"city": "LAKE SAINT LOUIS",
"state": "MO",
"postal_code": "633672660",
"telephone_number": "479-420-1320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STINE",
"first_name": "ANDREW",
"middle_name": "WAYNE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-02",
"last_updated": "2020-11-02",
"certification_date": "2020-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "043655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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- Joaquin Francisco Sumaya, D.C.
- Supporting Empty Arms
- The Children's Counseling Center
- The Hearing Center LLC
- Carolyn Ann Tinker, MA, PLPC, NCC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.