Provider Demographics
NPI:1356625941
Name:FOX, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 CATLIN DR
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1277
Mailing Address - Country:US
Mailing Address - Phone:636-461-1347
Mailing Address - Fax:636-461-1718
Practice Address - Street 1:1718 CATLIN DR
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-1277
Practice Address - Country:US
Practice Address - Phone:636-461-1347
Practice Address - Fax:636-461-1718
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist