Provider Demographics
NPI:1336144625
Name:PERNICIARO, PAUL G (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:PERNICIARO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7221
Mailing Address - Country:US
Mailing Address - Phone:636-391-7555
Mailing Address - Fax:636-391-7555
Practice Address - Street 1:2209 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7221
Practice Address - Country:US
Practice Address - Phone:636-391-7555
Practice Address - Fax:636-391-7555
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040586183500000X, 1835P1200X, 1835P1300X
IL183500000X, 1835P1200X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835P1300XPharmacy Service ProvidersPharmacistPsychiatric