Provider Demographics
NPI:1932241320
Name:FORUM CENTER PHARMACY INC
Entity Type:Organization
Organization Name:FORUM CENTER PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LEVISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-532-1646
Mailing Address - Street 1:67 FORUM SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3006
Mailing Address - Country:US
Mailing Address - Phone:314-434-2544
Mailing Address - Fax:314-434-0689
Practice Address - Street 1:67 FORUM SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3006
Practice Address - Country:US
Practice Address - Phone:314-434-2544
Practice Address - Fax:314-434-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108181543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2605511OtherNABP