Mac RX of Missouri, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

MAC RX OF MISSOURI, LLC

Practice address

3196 Riverport Tech Center Dr
Maryland Heights, MO 63043-4825

Phone

(314) 887-1720

NPI assigned

Feb 9, 2023

Organization subpart

No

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

Authorized official

Name

Jonathan Perez

Title

Coo

Phone

(314) 369-6447

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Abigale Rosebaugh

  • Pharmacist
  • Maryland Heights, MO
  • NPI 1164380580
  NPD (past)

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

{
    "created_epoch": "1675900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675900800000",
    "number": "1205533346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3196 RIVERPORT TECH CENTER DR",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630434825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3196 RIVERPORT TECH CENTER DR",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630434825",
            "telephone_number": "314-887-1720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAC RX OF MISSOURI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-09",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "314-369-6447"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phylicia Little, FNP-BC
• Ashley Liu, PHARMD
• Living Well Consumer Directed Services, LLC
• Alma Katigbak Lopez, OTR
• Leonard G Lucas, DO
• Pamela Michelle Macon, MPT
• Magellan Health Services
• Magellan Healthcare, Inc.
• Constance Mann, MSW, LCSW
• Katherine Lee Marshall, NP

• Long Term Care Pharmacy in Maryland Heights, MO
• Providers in Maryland Heights, MO by specialty
• Long Term Care Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.