Healthcare Provider Details

I. General information

NPI: 1043138225
Provider Name (Legal Business Name): PEVELY RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8640 COMMERCIAL BLVD
PEVELY MO
63070-1529
US

IV. Provider business mailing address

8640 COMMERCIAL BLVD
PEVELY MO
63070-1529
US

V. Phone/Fax

Practice location:
  • Phone: 636-479-6100
  • Fax: 636-479-6101
Mailing address:
  • Phone: 636-479-6100
  • Fax: 636-479-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MEGAN MOORE
Title or Position: BOOK KEEPER
Credential:
Phone: 636-579-6750