Kristen Renee Ma

Primary specialty

PharmacistTaxonomy code 183500000X

License

20110026099 Issued in MO

Practice address

15846 Manchester Road
Ellisville, MO 63011

Phone

(636) 527-6074

Fax

(636) 527-6456

NPI assigned

Nov 3, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1750098133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15846 MANCHESTER RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "63011",
            "telephone_number": "636-527-6074",
            "fax_number": "636-527-6456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15846 MANCHESTER ROAD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "63011",
            "telephone_number": "636-527-6074",
            "fax_number": "636-527-6456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MA",
        "first_name": "KRISTEN",
        "middle_name": "RENEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-03",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "20110026099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "patient",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "epic",
            "address_1": "15846 Manchester Rd",
            "city": "Ellisville",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630112208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Longevity Care LLC
• Melissa Kay Lorber, O.D.
• Elizabeth Lucas, MD
• Linda Lui, PHARM.D.
• Spencer Augustus Lunnemann, PHARMD
• Marcello Macellaio, DC
• Giovanna Mancuso
• Matthew John Markelz, ATC
• Jeffrey L Marlow, R.PH.
• Crystal Martin, D.D.S.

• Pharmacist in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.