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General NPI Number Information
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NPI Number | 1700929866
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Entity Type | Organization
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Legal Business Name | REHOBOTH PHARMACY LLC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 9944 W FLORISSANT AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63136-1432
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Country | US
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Telephone | 314-868-3333
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Fax | 314-867-2330
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Provider Business Mailing Address
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Address Line | 9944 W FLORISSANT AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63136-1432
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Country | US
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Telephone | 314-868-3333
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Fax | 314-867-2330
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Authorized Official
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Title or Position | PIC
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Name | IDOWU AJIBOLA
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Credential |
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Telephone | 314-249-3176
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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 | 200700836
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License Number State | MO
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