Active NPI
Tilford A. Brockett Jr.
- Pharmacist
- Saint Louis, MO
National Provider Identifier
1295089662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 15314
- Practice address
- 12647 Olive Blvd
Ste 600
Saint Louis, MO 63141-6393 - Phone
- (314) 744-4107
- Fax
- (877) 685-9866
- NPI assigned
- Nov 6, 2012
- 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 | 15314 | MD | Primary |
Addresses
Primary practice location
12647 Olive Blvd
Ste 600
Saint Louis, MO 63141-6393
Mailing address
12647 Olive Blvd
Ste 600
Saint Louis, MO 63141-6393
Phone (314) 744-4107
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 |
|---|---|---|---|
| 15314 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1352160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352160000000",
"number": "1295089662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12647 OLIVE BLVD",
"address_2": "STE 600",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416393",
"telephone_number": "314-744-4107",
"fax_number": "877-685-9866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12647 OLIVE BLVD",
"address_2": "STE 600",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416393",
"telephone_number": "314-744-4107",
"fax_number": "877-685-9866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKETT",
"first_name": "TILFORD",
"middle_name": "A.",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-06",
"last_updated": "2012-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "15314",
"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 Nov 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.