Organization
PEVELY RX
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON ALEXANDER WANG PHARMD (PRESIDENT)
(314) 753-8851
Entity
Organization
Contact information
Practice address
8640 COMMERCIAL BLVD, PEVELY, MO 63070-1529
(636) 479-6100
(636) 479-6101
Mailing address
8640 COMMERCIAL BLVD, PEVELY, MO 63070-1529
(636) 479-6100
(636) 479-6101
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2012030942
MO
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2136810
PK
—
05
—
606585404
—
MO
Enumeration date
09/02/2012
Last updated
06/10/2024
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