Provider Demographics
NPI:1740537554
Name:CRIST, STEPHANIE MICHELLE (PHARMD, BCACP, BCGP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:CRIST
Suffix:
Gender:F
Credentials:PHARMD, BCACP, BCGP
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:MICHELLE
Other - Last Name:SEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, BCACP, CGP
Mailing Address - Street 1:1393 VIRGINIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011
Mailing Address - Country:US
Mailing Address - Phone:314-973-0726
Mailing Address - Fax:
Practice Address - Street 1:520 MARYVILLE CENTRE DR STE 500
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5840
Practice Address - Country:US
Practice Address - Phone:314-364-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4464671835G0303X
MO20130262431835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric