JUSTIN CLARKE LIEDKE (NPI# 1639787328) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639787328 |
| Entity Type | Individual |
| Full Name | JUSTIN CLARKE LIEDKE |
| Credential | PHARM.D. |
| Practice Address |
915 N Grand Blvd Saint Louis MO 63106-1621 |
| Mailing Address |
1172 Warm Winds Dr O Fallon MO 63366-6305 |
| Practice Telephone | 3146524100 |
| Mailing Telephone | 6366974904 |
| Enumeration Date | 2020-07-19 |
| Last Update Date | 2020-07-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 2020018825 | MO | Pharmacy Service Providers |
| Street Address |
915 N GRAND BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63106-1621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033115480 | Jamie Lynn Swanson | Physician Assistant | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2005-06-21 |
| 1821602756 | Courtney Kay Duberry | Optometrist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-09-08 |
| 1043820053 | Kathryn Marie Storm | Pharmacist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-08-04 |
| 1326657230 | Rebecca Oluwafunmito Babalola | Pharmacist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-27 |
| 1639796899 | Taylor Anderson | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-02 |
| 1427675800 | Lauren Elizabeth Smith | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-01 |
| 1427675925 | Christa Marie Stoutenborough | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-06-30 |
| 1992322739 | Alexia Lambos Georges | Perfusionist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-06-27 |
| 1912522210 | Meaghan Elizabeth Lecture | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-06-11 |
| 1346863974 | Karishma Pallav Desai | Pharmacist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-05-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770027997 | Superior Manor of Downtown LLC | Assisted Living Facility | 1501 Clinton St., St Louis, MO 63106 | 2016-12-07 |
| 1811361454 | James Preston Jr. | Pharmacist | 915 N. Grand Vlvd, Pharmacy Dept., John Cochran Va Medical Center, Saint Louis, MO 63106 | 2015-11-19 |
| 1245656354 | Julie Marie Albsmeyer | Physician Assistant | 915 North Grand 111-jc-gi, John Cochran Va Hospital, St. Louis, MO 63106 | 2014-03-13 |
| 1932523230 | Cathy Yeung | Registered Nurse | 715 N Grand Blvd., St Louis, MO 63106 | 2014-02-07 |
| 1902149388 | Amanda Foley | Doula | 4056 Humphrey Street, Saint Louis, MO 63106 | 2013-04-03 |
| 1942569876 | Cornelia Charles | Internal Medicine | 915 Norh Grand Blvd, Saint Louis, MO 63106 | 2012-05-12 |
| 1124334396 | Kasandra Ann Tinajero | Registered Nurse | 915 N. Grand Blvd., St. Louis, MO 63106 | 2010-08-26 |
| 1366673931 | Cassandra Vernetta Talbert | Social Worker | 915 N. Grand., 122/jc Social Work Dept. V.a. Medical Center, St. Louis, MO 63106 | 2009-07-30 |
| 1497910707 | Robert Louis Tillman | Pharmacy Technician | 915 N Grand Ave, St. Louis, MO 63106 | 2008-07-25 |
| 1861676686 | Bradley Dean Overmeyer | Social Worker | 915 N Grand Blvd., Social Work Service, St. Louis, MO 63106 | 2007-12-28 |
| Find all providers in zip 63106 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457959736 | Andrea Williams | Pharmacist | 13231 Windbrooke Ln, Saint Louis, MO 63146-2221 | 2020-10-09 |
| 1417564196 | Barbara Rodgers | Pharmacist | 4700 N Hanley Rd Ste 256, Saint Louis, MO 63134-2700 | 2020-09-28 |
| 1396358339 | Michael A Heltzel | Pharmacist | 630 Emerson Rd Apt 307, Saint Louis, MO 63141-6764 | 2020-08-28 |
| 1295345866 | Elyar Gasanli | Pharmacist | 159 Lindbergh Place Dr, Saint Louis, MO 63146-5902 | 2020-08-07 |
| 1063039360 | Brad Collins | Pharmacist | 4240 Duncan Ave Ste 200, Saint Louis, MO 63110-1123 | 2020-07-02 |
| 1932720182 | Thomas Valiaparampil | Pharmacist | 7328 Cheshire Ln, Saint Louis, MO 63123-2125 | 2020-04-29 |
| 1467080945 | Ehikhuemhen Enaholo | Pharmacist | 5132 Waterman Blvd Apt 209, Saint Louis, MO 63108-1137 | 2020-03-30 |
| 1700425204 | Mena Khaled | Pharmacist | 9031 Big Chief Dr, Saint Louis, MO 63123-6605 | 2019-12-31 |
| 1952964652 | Almir Muharemovic | Pharmacist | 1205 Mangrove Ln Apt 6, Saint Louis, MO 63125-5631 | 2019-04-17 |
| 1215496518 | Ryan Freund | Pharmacist | 1861 Craig Park Ct, Saint Louis, MO 63146-4122 | 2019-03-16 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63106 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.