Provider Demographics
NPI:1457007049
Name:MARE, SUNEETHA (PHD, RPH)
Entity Type:Individual
Prefix:DR
First Name:SUNEETHA
Middle Name:
Last Name:MARE
Suffix:
Gender:F
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WATERFRONT GRV
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4816
Mailing Address - Country:US
Mailing Address - Phone:636-373-7966
Mailing Address - Fax:
Practice Address - Street 1:5819 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6948
Practice Address - Country:US
Practice Address - Phone:636-373-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009003343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist