Organization
KIKO ENTERPRISES, LLC
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN HINTERLONG (OWNER)
(636) 629-2022
Entity
Organization
Contact information
Practice address
920 H ST CLAIR PLAZA DR, ST CLAIR, MO 63077
(636) 629-2022
(636) 629-2082
Mailing address
920 M ST CLAIR PLAZA DR, ST CLAIR, MO 63077
(636) 629-2022
(636) 629-2082
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
005448
MO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2051500
PK
—
05
—
602188203
—
MO
Enumeration date
11/20/2006
Last updated
02/23/2017
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