=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225342405
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MED ASSIST PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2010
-----------------------------------------------------
Last Update Date | 07/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11551 ADIE RD
-----------------------------------------------------
City | MARYLAND HEIGHTS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63043-3517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-739-6815
-----------------------------------------------------
Fax | 314-344-4303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11551 ADIE RD
-----------------------------------------------------
City | MARYLAND HEIGHTS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-739-6815
-----------------------------------------------------
Fax | 314-344-4303
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ERIC BAILEY
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 314-739-6815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 2010016217
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------