Provider Demographics
NPI:1114200797
Name:SITA, MICHAEL JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:SITA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7339 GRAVOIS AVE
Mailing Address - Street 2:WALGREENS #3906
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-1040
Mailing Address - Country:US
Mailing Address - Phone:314-752-0722
Mailing Address - Fax:314-752-0226
Practice Address - Street 1:7339 GRAVOIS AVE
Practice Address - Street 2:WALGREENS #3906
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-1040
Practice Address - Country:US
Practice Address - Phone:314-752-0722
Practice Address - Fax:314-752-0226
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029435183500000X
IL051031158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1932116944OtherNPI NUMBER
MO2630970OtherNABP NUMBER
MO361924025OtherTAX ID
MO361924025OtherTAX ID