Provider Demographics
NPI:1558646703
Name:WESTON, KERRIE LEE (RPH)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:LEE
Last Name:WESTON
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 1:1303 WHISPERING PINES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4543
Mailing Address - Country:US
Mailing Address - Phone:954-873-5533
Mailing Address - Fax:
Practice Address - Street 1:12661 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6333
Practice Address - Country:US
Practice Address - Phone:314-878-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000148965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist