Provider Demographics
NPI:1144942921
Name:ENGEMANN, DONALD GERARD
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:GERARD
Last Name:ENGEMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 WASHINGTON CORS
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4603
Mailing Address - Country:US
Mailing Address - Phone:636-239-7483
Mailing Address - Fax:
Practice Address - Street 1:890 WASHINGTON CORS
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4603
Practice Address - Country:US
Practice Address - Phone:636-239-7483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023033241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist