Organization
FREDERICKTOWN MEDICATE PHARMACY
Active
Other names
MEDICATE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK OBRIEN RPH (OWNER)
(573) 783-5508
Entity
Organization
Contact information
Practice address
111 E MAIN ST, FREDERICKTOWN, MO 63645-1123
(573) 783-5508
(573) 783-3289
Mailing address
111 E MAIN ST, FREDERICKTOWN, MO 63645-1123
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
002797
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2606501
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
600203301
—
MO
05
—
620203307
—
MO
Enumeration date
06/22/2006
Last updated
12/12/2008
Update your record
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