Organization
MEDICAL WEST PHARMCAY, INC
Active
Other names
Medical West Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL K LANE JR. (CFO)
(314) 993-7900
Entity
Organization
Contact information
Practice address
4630 MEXICO RD, SAINT PETERS, MO 63376-1607
(636) 477-1888
Mailing address
9301 DIELMAN INDUSTRIAL DR, SAINT LOUIS, MO 63132-2204
(314) 993-7900
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29775
BLUECROSS BLUE SHIELD MO
MO
01
—
6903
GROUP HEALTH PLAN
MO
Enumeration date
09/20/2006
Last updated
04/20/2008
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