Provider Demographics
NPI:1114023801
Name:CHALLEN, LAURA MORETTI (PHARMD, BCPS, MBA)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MORETTI
Last Name:CHALLEN
Suffix:
Gender:F
Credentials:PHARMD, BCPS, MBA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:VIRGINIA
Other - Last Name:MORETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4588 PARKVIEW PLACE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-446-8512
Mailing Address - Fax:314-446-8500
Practice Address - Street 1:4901 FOREST PARK AVE., FLOOR 2
Practice Address - Street 2:BARNES-JEWISH HOSPITAL, CENTER FOR OUTPATIENT HEALTH
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108
Practice Address - Country:US
Practice Address - Phone:314-362-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43431183500000X
MO2011038925183500000X
MAPH26411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist