Provider Demographics
NPI:1831879576
Name:FENTON, ELIZABETH CHRISTINA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTINA
Last Name:FENTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1423
Mailing Address - Country:US
Mailing Address - Phone:314-756-3013
Mailing Address - Fax:
Practice Address - Street 1:9801 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1227
Practice Address - Country:US
Practice Address - Phone:314-963-3256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician