Provider Demographics
NPI:1629679204
Name:KRUS, RILEY MARIE
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:MARIE
Last Name:KRUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9541 LODGE POLE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2123
Mailing Address - Country:US
Mailing Address - Phone:314-605-8416
Mailing Address - Fax:
Practice Address - Street 1:1900 MAPLEWOOD COMMONS DR
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-1005
Practice Address - Country:US
Practice Address - Phone:314-781-2935
Practice Address - Fax:314-781-3254
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015029223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist