Organization
MEDICAL WEST PHARMACY, INC
Active
Other names
Medical West Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH ALAN SANDLER (PRESIDENT)
(314) 993-7900
Entity
Organization
Contact information
Practice address
19 RONNIES PLZ, SAINT LOUIS, MO 63126-3552
(314) 290-2200
(314) 902-2220
Mailing address
9301 DIELMAN INDUSTRIAL DR, SAINT LOUIS, MO 63132-2204
(314) 993-7900
(314) 569-5056
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
850200908
MO
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
10803009
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181658
ANTHEM BLUE CROSS BLUE SHIELD
MO
01
—
612829
HEALTHLINK
—
05
—
620200907
—
MO
Enumeration date
02/23/2009
Last updated
06/11/2012
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