Active NPI
Jamie Rusan, PHARMD
- Pharmacist
- Florissant, MO
National Provider Identifier
1366274151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2024010093
- Practice address
- 1160 Shackelford Rd
Florissant, MO 63031-4369 - Phone
- (314) 838-4660
- NPI assigned
- Aug 19, 2024
- 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 | 2024010093 | MO | Primary |
Addresses
Primary practice location
1160 Shackelford Rd
Florissant, MO 63031-4369
Mailing address
4263 Manchester Ave # F
Saint Louis, MO 63110-3850
Phone (314) 305-0207
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 |
|---|---|---|---|
| 2024010093 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724025600000",
"number": "1366274151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4263 MANCHESTER AVE # F",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631103850",
"telephone_number": "314-305-0207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1160 SHACKELFORD RD",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630314369",
"telephone_number": "314-838-4660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSAN",
"first_name": "JAMIE",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-08-19",
"last_updated": "2024-08-19",
"certification_date": "2024-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2024010093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florissant, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.