MEDICARE: RINDERER'S DRUG STORE #1

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	3336C0003X	Community/Retail Pharmacy	PS000409	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2602793	OTHER		NCPDP

General Provider Information

NPI Number	:	1437140282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RINDERER'S DRUG STORE #1

Provider Business Mailing Address
First Line	:	4447 NATURAL BRIDGE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2626
Country	:	US
Telephone Number	:	314-381-0501
Fax Number	:

Provider Business Practice Location Address
First Line	:	4447 NATURAL BRIDGE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2626
Country	:	US
Telephone Number	:	314-381-0501
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MATTHEW JAY CARLISLE
Credential	:	R.PH.
Telephone Number	:	636-928-3957

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	08/22/2020

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