Healthcare Provider Details

I. General information

NPI: 1558473157
Provider Name (Legal Business Name): PHARMAX BT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 NESBIT DR SUITE A
BONNE TERRE MO
63628-1368
US

IV. Provider business mailing address

60 NESBIT DR SUITE A
BONNE TERRE MO
63628-1368
US

V. Phone/Fax

Practice location:
  • Phone: 573-358-3301
  • Fax:
Mailing address:
  • Phone: 573-358-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LARRY MCINTOSH
Title or Position: PRESIDENT
Credential:
Phone: 314-954-5510