Active NPI
Mary Jo Faulkner
- Pharmacist
- Ballwin, MO
National Provider Identifier
1790069284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2000165339
- Practice address
- 13992 Manchester Rd
Ballwin, MO 63011-4517 - Phone
- (636) 227-9228
- NPI assigned
- Oct 4, 2011
- Sex
- Female
- Sole proprietor
- No
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 | 2000165339 | MO | Primary |
Addresses
Primary practice location
13992 Manchester Rd
Ballwin, MO 63011-4517
Mailing address
1724 Wade Rd
Pacific, MO 63069-4911
Phone (314) 306-2887
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 |
|---|---|---|---|
| 2000165339 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317686400000",
"number": "1790069284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1724 WADE RD",
"city": "PACIFIC",
"state": "MO",
"postal_code": "630694911",
"telephone_number": "314-306-2887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13992 MANCHESTER RD",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630114517",
"telephone_number": "636-227-9228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAULKNER",
"first_name": "MARY",
"middle_name": "JO",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-04",
"last_updated": "2011-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2000165339",
"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 Oct 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.