Provider Demographics
NPI:1487256244
Name:WOERFEL, MAX DOUGLAS (PHARMD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:DOUGLAS
Last Name:WOERFEL
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 1:4643 LINDELL BLVD APT 416
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3728
Mailing Address - Country:US
Mailing Address - Phone:586-216-4613
Mailing Address - Fax:
Practice Address - Street 1:4643 LINDELL BLVD APT 416
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3728
Practice Address - Country:US
Practice Address - Phone:586-216-4613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019035650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019035650OtherPHARMACIST LICENSE