Provider Demographics
NPI:1912957770
Name:TWOMEY, K THERESE (RPH, JD)
Entity Type:Individual
Prefix:
First Name:K
Middle Name:THERESE
Last Name:TWOMEY
Suffix:
Gender:F
Credentials:RPH, JD
Other - Prefix:
Other - First Name:K
Other - Middle Name:THERESE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH,JD
Mailing Address - Street 1:2174 AVALON RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7806
Mailing Address - Country:US
Mailing Address - Phone:636-861-6069
Mailing Address - Fax:
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-9921
Practice Address - Fax:314-454-5399
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO41391183500000X
CA40516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist