Organization
PHARMAX INC.
Active
Other names
Pharmax Pharmacy #1108
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY T MCINTOSH (PRESIDENT)
(314) 954-5510
Entity
Organization
Contact information
Practice address
305 HOVEN DR, PACIFIC, MO 63069-1157
(636) 257-4660
Mailing address
305 HOVEN DR, PACIFIC, MO 63069-1157
(636) 257-4660
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
621679802
MO
3336C0003X
Community/Retail Pharmacy
Primary
2000164238
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2627466
NCPDP #
MO
05
—
601679806
—
MO
01
—
621679802
MEDICAID DME
MO
Enumeration date
08/31/2006
Last updated
03/07/2023
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