MEDICARE: GLOBE SELF SERVICE DRUG INCORPORATED

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	027785	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2610992	OTHER	MO	NABP

General Provider Information

NPI Number	:	1679616536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBE SELF SERVICE DRUG INCORPORATED

Provider Business Mailing Address
First Line	:	2626 CHEROKEE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3130
Country	:	US
Telephone Number	:	314-865-1024
Fax Number	:	314-664-7713

Provider Business Practice Location Address
First Line	:	2626 CHEROKEE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3130
Country	:	US
Telephone Number	:	314-865-1024
Fax Number	:	314-664-7713

Authorized Official
Title or Position	:	CHIEF PHARMACIST
Name	:	MR. SANFORD COHEN
Credential	:	PHARMACIST
Telephone Number	:	314-865-1024

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/22/2020

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