Healthcare Provider Details

I. General information

NPI: 1831261627
Provider Name (Legal Business Name): MACHAJ RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3137 S GRAND BLVD
SAINT LOUIS MO
63118-1020
US

IV. Provider business mailing address

3137 S GRAND BLVD
SAINT LOUIS MO
63118-1020
US

V. Phone/Fax

Practice location:
  • Phone: 314-865-1528
  • Fax: 314-865-5219
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2000153376
License Number StateMO

VIII. Authorized Official

Name: DENISE MACHAJ
Title or Position: OWNER
Credential: RPH
Phone: 314-865-1528