Healthcare Provider Details

I. General information

NPI: 1063418523
Provider Name (Legal Business Name): MEDICATE PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 8TH ST STE 100
EAST SAINT LOUIS IL
62201-2989
US

IV. Provider business mailing address

100 N 8TH ST SUITE 100
EAST SAINT LOUIS IL
62201-2989
US

V. Phone/Fax

Practice location:
  • Phone: 618-875-1000
  • Fax: 618-875-2540
Mailing address:
  • Phone: 618-875-1000
  • Fax: 618-875-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054-014315
License Number StateIL

VIII. Authorized Official

Name: MR. MICHAEL L. SCHALTENBRAND
Title or Position: OWNER
Credential: RPH
Phone: 618-875-1000