Organization
DIERBERGS MARKETS INC
Active
Other names
DIERBERGS EDWARDSVILLE CROSSING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY GUENTHER (DIRECTOR OF PHARMACY)
(636) 812-1470
Entity
Organization
Contact information
Practice address
6671 EDWARDSVILLE CROSSING DRIVE, EDWARDSVILLE, IL 62025
(618) 307-3817
(618) 307-3816
Mailing address
PO BOX 1070, CHESTERFIELD, MO 63006-1070
(636) 812-1470
(636) 812-1603
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
54015911
IL
3336C0003X
Community/Retail Pharmacy
Primary
54015911
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1480071
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/13/2006
Last updated
10/02/2008
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