Organization
REHOBOTH PHARMACY LLC
Active
Other names
REHOBOTH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
IDOWU AJIBOLA (PIC)
(314) 249-3176
Entity
Organization
Contact information
Practice address
9944 W FLORISSANT AVE, SAINT LOUIS, MO 63136-1432
(314) 868-3333
(314) 867-2330
Mailing address
9944 W FLORISSANT AVE, SAINT LOUIS, MO 63136-1432
(314) 868-3333
(314) 867-2330
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
200700836
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2637354
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
606309003
—
MO
Enumeration date
02/15/2007
Last updated
08/20/2010
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