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General NPI Number Information
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NPI Number | 1427069939
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Entity Type | Organization
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Legal Business Name | MEDICAL ARTS PHARMACY
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 10/26/2013
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Provider Practice Location Address
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Address Line | 1935 PRAIRIE DELL RD SUITE 200
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City | UNION
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State | MO
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Zip | 63084-4328
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Country | US
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Telephone | 636-583-3117
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Fax | 636-583-3666
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Provider Business Mailing Address
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Address Line | 1823 WISHWOOD DR
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City | WASHINGTON
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State | MO
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Zip | 63090-3415
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Country | US
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Telephone | 636-239-4368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEITH GOERS
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Credential | RPH
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Telephone | 636-239-4368
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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 |
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License Number State |
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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 | 004795
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License Number State | MO
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