Organization
STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
Active
Other names
Bloomsdale Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA WOLK (BUSINESS OFFICE DIRECTOR)
(573) 883-7703
Entity
Organization
Contact information
Practice address
255 BODERMAN, SUITE 1E, BLOOMSDALE, MO 63627
(573) 483-2626
(573) 883-1185
Mailing address
255 BODERMAN, SUITE 1E, BLOOMSDALE, MO 63627-9099
(573) 483-2626
(573) 883-1185
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2012036011
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137520
PK
—
05
—
600004992
—
MO
Enumeration date
10/17/2012
Last updated
01/13/2023
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