Healthcare Provider Details

I. General information

NPI: 1972617942
Provider Name (Legal Business Name): BIRDSONG REXALL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E SAINT LOUIS ST
PACIFIC MO
63069-1549
US

IV. Provider business mailing address

101 E SAINT LOUIS ST
PACIFIC MO
63069-1549
US

V. Phone/Fax

Practice location:
  • Phone: 636-271-3450
  • Fax: 636-271-7946
Mailing address:
  • Phone: 636-271-3450
  • Fax: 636-271-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number002652
License Number StateMO

VIII. Authorized Official

Name: MARY PUND
Title or Position: PRESIDENT
Credential:
Phone: 636-271-3450