Healthcare Provider Details

I. General information

NPI: 1922170711
Provider Name (Legal Business Name): DE SOTO DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/07/2023
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MAIN ST
DE SOTO MO
63020-1709
US

IV. Provider business mailing address

100 N MAIN ST
DE SOTO MO
63020-1709
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-5533
  • Fax: 636-337-5533
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number004653
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number004653
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number004653
License Number StateMO

VIII. Authorized Official

Name: CHARLES ANTHONY ARGANA
Title or Position: PHARMACIST IN CHARGE
Credential: R.PH.
Phone: 636-586-5533