Organization
CRESCENT UNITED LLC
Active
Other names
DirectRx Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IHTESHAM GOHAR PHARMD (OWNER)
(636) 675-1123
Entity
Organization
Contact information
Practice address
140 ENCHANTED PKWY, SUITE 100, MANCHESTER, MO 63021-5491
(636) 675-1123
Mailing address
140 ENCHANTED PKWY, SUITE 100, MANCHESTER, MO 63021-5491
(636) 675-1123
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2014032156
MO
3336C0004X
Compounding Pharmacy
2014032156
MO
Other
Enumeration date
09/10/2014
Last updated
09/10/2014
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