| NPI | 1114973716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIC PERINI Assistant Secretary 314-684-6273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: LA PHY005289RC) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| 3336H0001X Pharmacy Home Infusion Therapy Pharmacy | |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2019-10-07 |