Organization
LAKE FOREST PHARMACY
Active
Other names
Lakeforest Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS WEGRZYN (OWNER)
(636) 856-9555
Entity
Organization
Contact information
Practice address
950 CORPORATE PKWY STE 104, WENTZVILLE, MO 63385-4851
(636) 856-9555
(866) 548-7855
Mailing address
950 CORPORATE PKWY STE 104, WENTZVILLE, MO 63385-4851
(636) 856-9555
(866) 548-7855
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2017018401
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2169645
PK
—
Enumeration date
06/16/2017
Last updated
12/08/2019
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