MEDICARE: TPD PHARMACY

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
2	3336C0003X	Community/Retail Pharmacy	2017010896	MO

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	2168841	OTHER		PK

General Provider Information

NPI Number	:	1174056642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TPD PHARMACY

Provider Business Mailing Address
First Line	:	5937 W FLORISSANT AVE STE 1
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-4952
Country	:	US
Telephone Number	:	314-381-2224
Fax Number	:	314-381-1771

Provider Business Practice Location Address
First Line	:	5937 W FLORISSANT AVE STE 1
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-4952
Country	:	US
Telephone Number	:	314-381-2224
Fax Number	:	314-381-1771

Authorized Official
Title or Position	:	OWNER
Name	:	TRACY REED
Credential	:	PODIATRIST
Telephone Number	:	314-381-2224

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	07/27/2018

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Directions to “TPD PHARMACY ” Practice Location

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