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General NPI Number Information
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NPI Number | 1265521934
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Entity Type | Organization
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Legal Business Name | DIERBERGS MARKETS INC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 2460 TAYLOR RD
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City | GROVER
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State | MO
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Zip | 63040-1222
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Country | US
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Telephone | 636-458-7450
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Fax | 636-530-3002
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Provider Business Mailing Address
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Address Line | PO BOX 1070
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City | CHESTERFIELD
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State | MO
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Zip | 63006-1070
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Country | US
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Telephone | 636-812-1470
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Fax | 636-812-1603
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | GREGORY GUENTHER
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Credential |
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Telephone | 636-812-1470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2003031656
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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