Healthcare Provider Details

I. General information

NPI: 1629578927
Provider Name (Legal Business Name): PACIFIC RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 W OSAGE ST
PACIFIC MO
63069-1131
US

IV. Provider business mailing address

2290 W OSAGE ST
PACIFIC MO
63069-1131
US

V. Phone/Fax

Practice location:
  • Phone: 636-257-9777
  • Fax: 636-257-9774
Mailing address:
  • Phone: 636-257-9777
  • Fax: 636-257-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2018004232
License Number StateMO

VIII. Authorized Official

Name: KRISHNA CHALUVADI
Title or Position: DIRECTOR
Credential:
Phone: 636-257-9777