MEDICARE: THOMAS JOSEPH STORCK I RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH040757	MO

General Provider Information

NPI Number	:	1194008128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOSEPH STORCK I RPH

Provider Business Mailing Address
First Line	:	2337 S COMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1705
Country	:	US
Telephone Number	:	314-772-7665
Fax Number	:

Provider Business Practice Location Address
First Line	:	2337 S COMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1705
Country	:	US
Telephone Number	:	314-772-7665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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