MEDICARE: RINDERER'S DRUG STORE #8

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	3336C0003X	Community/Retail Pharmacy	PS004734	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2623949	OTHER		NCPDP

General Provider Information

NPI Number	:	1912964743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RINDERER'S DRUG STORE #8

Provider Business Mailing Address
First Line	:	44 N FLORISSANT RD
Second Line	:
City	:	FERGUSON
State	:	MO
Zip	:	63135-2332
Country	:	US
Telephone Number	:	314-521-2721
Fax Number	:	314-521-2721

Provider Business Practice Location Address
First Line	:	44 N FLORISSANT RD
Second Line	:
City	:	FERGUSON
State	:	MO
Zip	:	63135-2332
Country	:	US
Telephone Number	:	314-521-2721
Fax Number	:	314-521-2721

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MATTHEW JAY CARLISLE
Credential	:	R.PH.
Telephone Number	:	636-928-3957

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	08/22/2020

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