Individual provider · Type 1 NPI

Jessie Icenogle, PharmD

Pharmacist · St. Louis, MO

NPI number 1235096488 Active

Practice location

1201 S Grand Blvd
St. Louis, MO 63104-1016

Call (314) 257-8000 Map

Mailing address

1107 Ralph Ter
Richmond Heights, MO 63117-1528

Specialties and licenses

TaxonomyCodeLicense
Pharmacist Primary 183500000X2025032722 (MO)

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…

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About NPI 1235096488

Jessie Icenogle, PharmD's National Provider Identifier is 1235096488, issued on Jan 8, 2026. The primary taxonomy on file is Pharmacist (183500000X), and the practice location is in St. Louis, MO. The record was last updated on Jan 8, 2026.