Provider Demographics
NPI:1700162567
Name:FEDERMAN, STUART DAVID (PHARMD, AAHIVE)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:DAVID
Last Name:FEDERMAN
Suffix:
Gender:M
Credentials:PHARMD, AAHIVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 NATURAL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-5151
Mailing Address - Country:US
Mailing Address - Phone:314-381-8600
Mailing Address - Fax:314-381-6844
Practice Address - Street 1:7150 NATURAL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-5151
Practice Address - Country:US
Practice Address - Phone:314-381-8600
Practice Address - Fax:314-381-6844
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007023343183500000X
IL051292647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600201206Medicaid