Provider Demographics
NPI:1720326028
Name:CHAMNESS, MALCOLM RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:RYAN
Last Name:CHAMNESS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-4328
Mailing Address - Country:US
Mailing Address - Phone:314-427-3763
Mailing Address - Fax:
Practice Address - Street 1:3300 BROWN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-4328
Practice Address - Country:US
Practice Address - Phone:314-427-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist