Jeanine M Badwan, PHARMD
Individual provider Active NPI Pharmacist · O Fallon, MO
NPI 1962015487 · NPPES record last updated Aug 25, 2020
Key facts
- NPI
- 1962015487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2019032437 (MO)
- Practice address
- 920 N Main St
O Fallon, MO 63366-1746 - Phone
- (636) 379-2636
- NPI assigned
- Aug 25, 2020
- 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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019032437 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2019032437 | MO | Yes |
Addresses
Primary practice location
920 N Main St
O Fallon, MO 63366-1746
Mailing address
2903 Post Glen CT
O Fallon, MO 63368-7056
Phone (314) 359-5957
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 906495075 | Other | UNITED HEALTH CARE |
Other providers in O Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2020. 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.