=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437140282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RINDERER'S DRUG STORE #1
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4447 NATURAL BRIDGE AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63115-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-381-0501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4447 NATURAL BRIDGE AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63115-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-381-0501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MATTHEW JAY CARLISLE
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 636-928-3957
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PS000409
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------