Provider Demographics
NPI:1740648476
Name:ALICIA B BARISHMAN
Entity type:Organization
Organization Name:ALICIA B BARISHMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BARISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-972-2259
Mailing Address - Street 1:991 HAVERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-1645
Mailing Address - Country:US
Mailing Address - Phone:314-972-2259
Mailing Address - Fax:
Practice Address - Street 1:991 HAVERSHAM DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-1645
Practice Address - Country:US
Practice Address - Phone:314-972-2259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPH044156333600000X
FLPS30150333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy