Organization
DIERBERGS TOWN CENTER PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA MCDANIEL (STAFF PHARMACIST)
(636) 458-7450
Entity
Organization
Contact information
Practice address
2460 TAYLOR ROAD, WILDWOOD, MO 63040
(636) 458-7450
Mailing address
2460 TAYLOR ROAD, WILDWOOD, MO 63040
(636) 458-7450
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
2003031656
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
606120103
—
MO
Enumeration date
10/21/2015
Last updated
10/21/2015
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