Active NPI
Ethan Klutenkamper, PHARM D.
- Pharmacist
- Saint Louis, MO
National Provider Identifier
1205514833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2018032020
- Practice address
- 3933 S Broadway
Saint Louis, MO 63118-4601 - Phone
- (314) 865-7080
- NPI assigned
- Jul 5, 2023
- 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 | 2018032020 | MO | Primary |
Addresses
Primary practice location
3933 S Broadway
Saint Louis, MO 63118-4601
Mailing address
5624 Pernod Ave
Saint Louis, MO 63139-1506
Phone (636) 284-6712
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 |
|---|---|---|---|
| 2018032020 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688515200000",
"number": "1205514833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5624 PERNOD AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631391506",
"telephone_number": "636-284-6712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3933 S BROADWAY",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631184601",
"telephone_number": "314-865-7080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLUTENKAMPER",
"first_name": "ETHAN",
"name_prefix": "Dr.",
"credential": "PHARM D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-07-05",
"last_updated": "2023-07-05",
"certification_date": "2023-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2018032020",
"primary": true
}
],
"identifiers": [],
"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 Jul 5, 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.