Organization
MEDICAL WEST BALLAS PHARMACY LTD
Active
Other names
GOLDSMITH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SIDNEY KENT RPH (OWNER / PHARMACIST)
(314) 432-5020
Entity
Organization
Contact information
Practice address
777 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8705
(314) 432-5020
(314) 432-5026
Mailing address
777 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8705
(314) 432-5020
(314) 432-5026
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
005102
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2603757
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
600200919
—
MO
Enumeration date
09/12/2006
Last updated
02/07/2013
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