Organization
DEJACE ENTERPRISES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW OSTERKAMP (PHARMACIST)
(573) 898-2550
Entity
Organization
Contact information
Practice address
106A BROADWAY ST, ELSBERRY, MO 63343-1233
(573) 898-2550
(573) 898-5730
Mailing address
106A BROADWAY ST, ELSBERRY, MO 63343-1233
(573) 898-2550
(573) 898-5730
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
029059
MO
333600000X
Pharmacy
029059
MO
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
601684608
—
MO
05
—
62184604
—
MO
Enumeration date
09/27/2005
Last updated
02/14/2020
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