MEDICARE: DHI INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	005065	MO
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2601474	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1013076017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DHI INC.

Provider Business Mailing Address
First Line	:	550 1ST CAPITOL DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 1ST CAPITOL DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2726
Country	:	US
Telephone Number	:	636-946-6606
Fax Number	:	636-723-1366

Authorized Official
Title or Position	:	OWNER AND PIC
Name	:	DANIEL HOLLAWAY
Credential	:	RPH
Telephone Number	:	636-946-6606

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/31/2008

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Directions to “DHI INC. ” Practice Location

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