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General NPI Number Information
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NPI Number | 1659576205
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Entity Type | Organization
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Legal Business Name | FOREST PARK PHARMACY
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 3535 S. JEFFERSON AVE STE (S-1)
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City | ST LOUIS
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State | MO
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Zip | 63118
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Country | US
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Telephone | 314-645-9990
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Fax | 314-645-9989
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Provider Business Mailing Address
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Address Line | 3535 SOUTH JEFFERSON AVE STE S-1
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City | ST LOUIS
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State | MO
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Zip | 63118-3900
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Country | US
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Telephone | 314-645-9990
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Fax | 314-645-9989
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | AMIRA JAHIC
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Credential |
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Telephone | 314-645-9990
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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 | 2007014550
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License Number State | MO
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