Healthcare Provider Details

I. General information

NPI: 1255687398
Provider Name (Legal Business Name): POWERS FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 TECHNOLOGY DR STE 113
O FALLON MO
63368-7371
US

IV. Provider business mailing address

2315 TECHNOLOGY DR STE 113
O FALLON MO
63368-7371
US

V. Phone/Fax

Practice location:
  • Phone: 636-265-2924
  • Fax: 636-265-1306
Mailing address:
  • Phone: 636-265-2924
  • Fax: 636-265-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2012025803
License Number StateMO

VIII. Authorized Official

Name: MRS. SHARLENE G. POWERS
Title or Position: OWNER
Credential: RPH
Phone: 636-699-8031