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Contact Information

DIERBERGS TOWN CENTER PHARMACY
2460 TAYLOR ROAD
WILDWOOD, MO63040
 Phone: 636-458-7450
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for DIERBERGS TOWN CENTER PHARMACY

NPI Number 1710359484
LBN Legal business name DIERBERGS TOWN CENTER PHARMACY
Authorized official BRENDA MCDANIEL - (STAFF PHARMACIST)
Entity Organization
Organization subpart 1 No
Enumeration date 10/21/2015
Last updated 10/21/2015 - About 11 years ago
Identifiers
MO License # 2003031656
MO Medicaid 606120103
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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