Provider Demographics
NPI:1922103886
Name:STEVEN L HORST
Entity Type:Organization
Organization Name:STEVEN L HORST
Other - Org Name:HORST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-243-8173
Mailing Address - Street 1:2705 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2918
Mailing Address - Country:US
Mailing Address - Phone:573-243-8173
Mailing Address - Fax:573-243-8174
Practice Address - Street 1:2705 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2918
Practice Address - Country:US
Practice Address - Phone:573-243-8173
Practice Address - Fax:573-243-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20110349823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2050225OtherPK
MO601582901Medicaid
0307710001Medicare NSC