MEDICARE: ST CLAIR REXALL DRUG STORE

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	002865	MO
2	333600000X	Pharmacy	2865	MO
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2610271	OTHER	MO	NABP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720079551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST CLAIR REXALL DRUG STORE

Provider Business Mailing Address
First Line	:	855 N COMMERCIAL AVE
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1118
Country	:	US
Telephone Number	:	636-629-0710
Fax Number	:	636-629-4408

Provider Business Practice Location Address
First Line	:	855 N COMMERCIAL AVE
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1118
Country	:	US
Telephone Number	:	636-629-0710
Fax Number	:	636-629-4408

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SUSAN ELIZABETH LINDEMANN
Credential	:	RPH
Telephone Number	:	636-629-0710

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	08/02/2022

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Directions to “ST CLAIR REXALL DRUG STORE ” Practice Location

Language	Start Address	Practice Location

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