Provider Demographics
NPI:1174622278
Name:PRATT'S REXALL DRUGS, INC
Entity type:Organization
Organization Name:PRATT'S REXALL DRUGS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:WILLIMANN
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:573-237-3321
Mailing Address - Street 1:100 DWAYNE VON BEHREN DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MO
Mailing Address - Zip Code:63068-3207
Mailing Address - Country:US
Mailing Address - Phone:573-237-3321
Mailing Address - Fax:573-237-2005
Practice Address - Street 1:100 DWAYNE VON BEHREN DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MO
Practice Address - Zip Code:63068-3207
Practice Address - Country:US
Practice Address - Phone:573-237-3321
Practice Address - Fax:573-237-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000129310400000X, 314000000X
3336L0003X
MO1293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600447007Medicaid
MO620447003Medicaid
MO600447007Medicaid