Dierbergs Markets Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

54015911 Issued in IL

Legal business name

DIERBERGS MARKETS INC

Doing business as

DIERBERGS EDWARDSVILLE CROSSING PHARMACY

Practice address

6671 Edwardsville Crossing Drive
Edwardsville, IL 62025

Phone

(618) 307-3817

Fax

(618) 307-3816

NPI assigned

Oct 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gregory Guenther

Title

Director of Pharmacy

Phone

(636) 812-1470

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• DIERBERGS EDWARDSVILLE CROSSING PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222905600000",
    "number": "1033209077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1070",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630061070",
            "telephone_number": "636-812-1470",
            "fax_number": "636-812-1603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6671 EDWARDSVILLE CROSSING DRIVE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "62025",
            "telephone_number": "618-307-3817",
            "fax_number": "618-307-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIERBERGS MARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2008-10-02",
        "status": "A",
        "authorized_official_last_name": "GUENTHER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "636-812-1470"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "54015911",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "54015911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1480071",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIERBERGS EDWARDSVILLE CROSSING PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marion Elsa Gabou Dessalines, PA-C
• Robert Paul Devine, D.C.
• Kassidy Ann Dexheimer
• Mary Elizabeth Di Lisio, DMD
• Diane Gassiraro PC
• Sara Dinardo
• Taylor Marie Dittmer-Smith
• Debra Ann Dixon, DMD
• Katarina Dobrosavljevic, RN
• Catherine Don

• Community/Retail Pharmacy in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.