Healthcare Provider Details

I. General information

NPI: 1114793353
Provider Name (Legal Business Name): RX OUTREACH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10208 W FLORISSANT AVE
DELLWOOD MO
63136-2106
US

IV. Provider business mailing address

10208 W FLORISSANT AVE
DELLWOOD MO
63136-2106
US

V. Phone/Fax

Practice location:
  • Phone: 314-930-2185
  • Fax: 314-930-2186
Mailing address:
  • Phone: 314-930-2185
  • Fax: 314-930-2186

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: DR. SERGIO BARRANCO-MEDINA
Title or Position: CHIEF PHARMACY OFFICER - PHARMACIST
Credential: RPH
Phone: 314-477-4532