| NPI | 1285749226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN GUINN Medicaid Medicare Billing Spec 314-993-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: TX 19942) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2020-08-22 |