| NPI | 1912964743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JAY CARLISLE President 636-928-3957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MO PS004734) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2020-08-22 |