Peggy A Koenen, RPH
Individual provider Active NPI Pharmacist · High Ridge, MO
NPI 1487986717 · NPPES record last updated Feb 11, 2010
Key facts
- NPI
- 1487986717
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 040162 (MO)
- Practice address
- 4560 Gravois Village Ctr
High Ridge, MO 63049-1838 - Phone
- (636) 376-5000
- Fax
- (636) 677-1870
- NPI assigned
- Feb 11, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040162 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 040162 | MO | Yes |
Addresses
Primary practice location
4560 Gravois Village Ctr
High Ridge, MO 63049-1838
Mailing address
4560 Gravois Village Ctr
High Ridge, MO 63049-1838
Phone (636) 376-5000
Other providers in High Ridge, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.