Organization Name: | MEDICAL WEST PHARMACY, INC |
NPI Number: | 1104066778 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KENNETH ALAN SANDLER (PRESIDENT) |
Mailing Address: | 19 Ronnies Plz Saint Louis |
State: | MO US |
Postal Code: | 631263552 |
Phone Number: | 3142902200 |
Fax Number: | 3149022220 |
NPI Enumeration Date: | 02/23/2009 |
NPI Last Update Date: | 06/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 850200908 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |