Organization
GRAND MEDICAL GROUP LLC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
3137 S GRAND BLVD, SAINT LOUIS, MO 63118-1020
(314) 865-1528
(314) 865-5219
Mailing address
3137 S GRAND BLVD, SAINT LOUIS, MO 63118-1020
(314) 865-1528
(314) 865-5219
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2008019033
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2638027
NCPDP
MO
Enumeration date
06/17/2008
Last updated
08/15/2008
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