Healthcare Provider Details

I. General information

NPI: 1174453146
Provider Name (Legal Business Name): PARKVIEWRX MISSOURI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 DOCTORS PARK STE 7
CAPE GIRARDEAU MO
63703-4956
US

IV. Provider business mailing address

3920 MAIN ST STE 100
AMHERST NY
14226-3350
US

V. Phone/Fax

Practice location:
  • Phone: 573-803-2040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN WACLAWEK
Title or Position: COO
Credential:
Phone: 716-876-2323