# DIERBERGS MARKETS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DIERBERGS EDWARDSVILLE CROSSING PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033209077
- **Authorized official:** GREGORY GUENTHER (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (636) 812-1470

## Contact information

- **Practice address:** 6671 EDWARDSVILLE CROSSING DRIVE, EDWARDSVILLE, IL 62025
- **Practice address phone:** (618) 307-3817
- **Practice address fax:** (618) 307-3816
- **Mailing address:** PO BOX 1070, CHESTERFIELD, MO 63006-1070
- **Mailing address phone:** (636) 812-1470
- **Mailing address fax:** (636) 812-1603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 54015911 | IL | — |
| 3336C0003X | Community/Retail Pharmacy | 54015911 | IL | Yes |

## Other

- **Enumeration date:** 10/13/2006
- **Last updated:** 10/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1480071 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |