Healthcare Provider Details

I. General information

NPI: 1831225234
Provider Name (Legal Business Name): MEDICINE SHOPPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10056 SAINT CHARLES ROCK RD
SAINT ANN MO
63074-2022
US

IV. Provider business mailing address

10056 SAINT CHARLES ROCK RD
SAINT ANN MO
63074-2022
US

V. Phone/Fax

Practice location:
  • Phone: 314-429-6909
  • Fax: 314-426-5739
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number004481
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DENA FERMAN
Title or Position: THIRD PARTY PLAN COORDINATOR
Credential:
Phone: 314-993-6000