O'Fallon Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

O'FALLON PHARMACY, LLC

Doing business as

Cardinal Pharmacy

Practice address

108 Triad Ctr W
O Fallon, MO 63366-7541

Phone

(833) 347-4217

Fax

(877) 646-0735

NPI assigned

Jul 28, 2020

Last updated

Dec 8, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sierra Degomez

Title

Managing Member

Phone

(833) 347-4217

Specialties & licenses 2

Addresses

Other names 1

• Cardinal Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1285243972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 TRIAD CTR W",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633667541",
            "telephone_number": "833-347-4217",
            "fax_number": "877-646-0735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 TRIAD CTR W",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633667541",
            "telephone_number": "833-347-4217",
            "fax_number": "877-646-0735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "O'FALLON PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-28",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "DEGOMEZ",
        "authorized_official_first_name": "SIERRA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "833-347-4217"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardinal Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cardinal Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.