Healthcare Provider Details

I. General information

NPI: 1679616536
Provider Name (Legal Business Name): GLOBE SELF SERVICE DRUG INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 CHEROKEE ST
SAINT LOUIS MO
63118-3130
US

IV. Provider business mailing address

2626 CHEROKEE ST
SAINT LOUIS MO
63118-3130
US

V. Phone/Fax

Practice location:
  • Phone: 314-865-1024
  • Fax: 314-664-7713
Mailing address:
  • Phone: 314-865-1024
  • Fax: 314-664-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number027785
License Number StateMO

VIII. Authorized Official

Name: MR. SANFORD COHEN
Title or Position: CHIEF PHARMACIST
Credential: PHARMACIST
Phone: 314-865-1024