MEDICARE: MED ASSIST 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336L0003X	Long Term Care Pharmacy
5	3336C0003X	Community/Retail Pharmacy	2010016217	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2126026	OTHER		PK

General Provider Information

NPI Number	:	1225342405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED ASSIST PHARMACY

Provider Business Mailing Address
First Line	:	11551 ADIE RD
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043
Country	:	US
Telephone Number	:	314-739-6815
Fax Number	:	314-344-4303

Provider Business Practice Location Address
First Line	:	11551 ADIE RD
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-3517
Country	:	US
Telephone Number	:	314-739-6815
Fax Number	:	314-344-4303

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC BAILEY
Credential	:	PHARM D
Telephone Number	:	314-739-6815

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	07/19/2018

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