Healthcare Provider Details

I. General information

NPI: 1730244161
Provider Name (Legal Business Name): IMRAN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 N KINGSHIGHWAY BLVD STE 100
SAINT LOUIS MO
63115-1736
US

IV. Provider business mailing address

3737 N KINGSHIGHWAY BLVD STE 100
SAINT LOUIS MO
63115-1736
US

V. Phone/Fax

Practice location:
  • Phone: 314-381-9394
  • Fax: 314-381-8833
Mailing address:
  • Phone: 314-381-9394
  • Fax: 314-381-8833

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 Number5995
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: REHAN RANA
Title or Position: PIC
Credential:
Phone: 731-730-2092