Provider Demographics
NPI:1023383643
Name:NDEGWA, PATRICK K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:K
Last Name:NDEGWA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MARYVILLE CENTRE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5818
Mailing Address - Country:US
Mailing Address - Phone:314-506-2405
Mailing Address - Fax:
Practice Address - Street 1:550 MARYVILLE CENTRE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5818
Practice Address - Country:US
Practice Address - Phone:314-506-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15441183500000X
MO2011024504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist