Provider Demographics
NPI:1518567312
Name:JAIN, SUNIRA (RPH)
Entity Type:Individual
Prefix:
First Name:SUNIRA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 BARRETT HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5894
Mailing Address - Country:US
Mailing Address - Phone:314-496-3480
Mailing Address - Fax:
Practice Address - Street 1:196 THF BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1141
Practice Address - Country:US
Practice Address - Phone:636-728-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4600183500000X
MO2005020329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist