Provider Demographics
NPI:1558473157
Name:PHARMAX BT INC
Entity Type:Organization
Organization Name:PHARMAX BT INC
Other - Org Name:DBA PHARMAX PHARMACY #1365
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-954-5510
Mailing Address - Street 1:60 NESBIT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1368
Mailing Address - Country:US
Mailing Address - Phone:573-358-3301
Mailing Address - Fax:
Practice Address - Street 1:60 NESBIT DR
Practice Address - Street 2:SUITE A
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1368
Practice Address - Country:US
Practice Address - Phone:573-358-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2604937OtherNCPDP #
MO600446504Medicaid
MOBM4472712OtherDEA #
MO600446504Medicaid
MOMA1056Medicare PIN