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General NPI Number Information
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NPI Number | 1356891162
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Entity Type | Organization
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Legal Business Name | MEDICAL WEST RESPIRATORY PHARMACY, LLC
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 440 SOUTH BRENTWOOD BLVD
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City | CLAYTON
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State | MO
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Zip | 63105
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Country | US
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Telephone | 314-290-0333
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Fax |
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Provider Business Mailing Address
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Address Line | 9301 DIELMAN INDUSTRIAL DR
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City | SAINT LOUIS
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State | MO
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Zip | 63132-2204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | KENNETH SANDLER
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Credential |
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Telephone | 314-993-7920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | LC001502307
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License Number State | MO
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