Provider Demographics
NPI:1568050227
Name:EFFAN, NELLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:EFFAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 EDGAR RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4928
Mailing Address - Country:US
Mailing Address - Phone:314-805-7070
Mailing Address - Fax:
Practice Address - Street 1:810 EDGAR RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4928
Practice Address - Country:US
Practice Address - Phone:314-805-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003020526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist