Provider Demographics
NPI:1629017975
Name:KOHOUT, RICHARD JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:KOHOUT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 WHEELWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6658
Mailing Address - Country:US
Mailing Address - Phone:636-391-0368
Mailing Address - Fax:
Practice Address - Street 1:3844 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:SUNSET HILLS
Practice Address - State:MO
Practice Address - Zip Code:63127-1368
Practice Address - Country:US
Practice Address - Phone:314-525-0415
Practice Address - Fax:314-525-0401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO027499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2003002133OtherSTATE PHARMACY LICENSE NO
MO2003002133OtherSTATE PHARMACY LICENSE NO
MO2003002133OtherSTATE PHARMACY LICENSE NO