Healthcare Provider Details

I. General information

NPI: 1699889667
Provider Name (Legal Business Name): STEWARTS DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MAIN ST
WARRENTON MO
63383-2005
US

IV. Provider business mailing address

227 MAIN ST
WARRENTON MO
63383-2005
US

V. Phone/Fax

Practice location:
  • Phone: 636-456-3419
  • Fax: 636-456-4911
Mailing address:
  • Phone: 636-456-3419
  • Fax: 636-456-4911

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 Number004300
License Number StateMO

VIII. Authorized Official

Name: JOSEPH AMENT
Title or Position: PRES
Credential: RPH
Phone: 636-456-3419