Healthcare Provider Details

I. General information

NPI: 1093020356
Provider Name (Legal Business Name): PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MILLWELL DR STE A
MARYLAND HEIGHTS MO
63043-2512
US

IV. Provider business mailing address

212 MILLWELL DR SUITE A
MARYLAND HEIGHTS MO
63043-2512
US

V. Phone/Fax

Practice location:
  • Phone: 314-739-4270
  • Fax: 877-480-4986
Mailing address:
  • Phone: 877-480-4987
  • Fax: 877-480-4986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01055932
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARLENE WILSON
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 314-941-0480