Active NPI
Mario Everardo Coronado, RPH
- Pharmacist
- Ballwin, MO
National Provider Identifier
1538446554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 042517
- Practice address
- 731 Rockridge Dr
Ballwin, MO 63021-6615 - Phone
- (636) 227-4175
- NPI assigned
- Nov 4, 2011
- 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 | 042517 | MO | Primary |
Addresses
Primary practice location
731 Rockridge Dr
Ballwin, MO 63021-6615
Mailing address
731 Rockridge Dr
Ballwin, MO 63021-6615
Phone (636) 227-4175
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)
- Enrolled
- Credentials
- Registered Pharmacist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320364800000",
"number": "1538446554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "731 ROCKRIDGE DR",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630216615",
"telephone_number": "636-227-4175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "731 ROCKRIDGE DR",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630216615",
"telephone_number": "636-227-4175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORONADO",
"first_name": "MARIO",
"middle_name": "EVERARDO",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-04",
"last_updated": "2011-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "042517",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ballwin, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.