Provider Demographics
NPI:1093020356
Name:PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:PHARMACY SERVICES INC
Other - Org Name:PHARMACY SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-941-0480
Mailing Address - Street 1:212 MILLWELL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2512
Mailing Address - Country:US
Mailing Address - Phone:877-480-4987
Mailing Address - Fax:877-480-4986
Practice Address - Street 1:212 MILLWELL DR
Practice Address - Street 2:STE A
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2512
Practice Address - Country:US
Practice Address - Phone:314-739-4270
Practice Address - Fax:877-480-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO010559323336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2639207OtherNCPDP PROVIDER IDENTIFICATION NUMBER