Provider Demographics
NPI:1013931112
Name:BEHM, FRED V (RPH)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:V
Last Name:BEHM
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 1:8842 FOREST HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3030
Mailing Address - Country:US
Mailing Address - Phone:314-843-3733
Mailing Address - Fax:
Practice Address - Street 1:113 SAINT FRANCOIS PLZ
Practice Address - Street 2:
Practice Address - City:LEADINGTON
Practice Address - State:MO
Practice Address - Zip Code:63601-4454
Practice Address - Country:US
Practice Address - Phone:573-431-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO26049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist