Healthcare Provider Details

I. General information

NPI: 1235211467
Provider Name (Legal Business Name): RX OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3171 RIVERPORT TECH CENTER DR
MARYLAND HEIGHTS MO
63043-4825
US

IV. Provider business mailing address

3171-3183 RIVERPORT TECH CENTER DR
MARYLAND HEIGHTS MO
63043
US

V. Phone/Fax

Practice location:
  • Phone: 800-769-3880
  • Fax: 314-918-6908
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number2010034839
License Number StateMO

VIII. Authorized Official

Name: SERGIO BARRANCO
Title or Position: PHARMACIST-IN-CHARGE
Credential:
Phone: 314-477-4532