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NPI Code Detail

MEDICARE: SCHNUCK MARKETS INC

MEDICARE: SCHNUCK MARKETS INC
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
1163WD0400XDiabetes Educator Registered Nurse
2261QM2500XMedical Specialty Clinic/Center
3332B00000XDurable Medical Equipment & Medical Supplies
4333600000XPharmacy
53336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1942785704
Entity Type Code : Organization
Provider Name (Legal Business Name) : SCHNUCK MARKETS INC
Provider Business Mailing Address
First Line : 11420 LACKLAND RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-3559
Country : US
Telephone Number : 314-994-4902
Fax Number : 314-994-4586
Provider Business Practice Location Address
First Line : 1275 N TRUMAN BLVD
Second Line :
City : FESTUS
State : MO
Zip : 63028-1176
Country : US
Telephone Number : 636-937-4686
Fax Number : 636-937-1432
Authorized Official
Title or Position : MANAGER OF THIRD PARTY
Name : LISA M DOBBS
Credential :
Telephone Number : 314-994-4902
Provider Enumeration Date : 09/27/2018
Last Update Date : 01/27/2019

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Directions to “SCHNUCK MARKETS INC ” Practice Location

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