Dierbergs Markets, Incorporated

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

Legal business name

DIERBERGS MARKETS, INCORPORATED

Doing business as

Dierbergs Fenton Crossing Pharmacy

Practice address

450 Old Smizer Mill Rd.
Fenton, MO 63026

Phone

(636) 349-2666

Fax

(636) 530-3018

NPI assigned

Oct 12, 2006

Organization subpart

Yes

Parent organization

DIERBERGS MARKETS, INCORPORATEDAs reported in NPPES

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

Authorized official

Name

Greg Guenther

Title

Pharmacy Director

Phone

(636) 812-1472

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• DIERBERGS FENTON CROSSING PHARMACY Doing business as

Part of

Dierbergs Markets Incorporated

Locations

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1538258207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 OLD SMIZER MILL RD.",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "63026",
            "telephone_number": "636-349-2666",
            "fax_number": "636-530-3018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 OLD SMIZER MILL RD.",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "63026",
            "telephone_number": "636-349-2666",
            "fax_number": "636-530-3018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIERBERGS MARKETS, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIERBERGS MARKETS, INCORPORATED",
        "enumeration_date": "2006-10-12",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "GUENTHER",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "636-812-1472"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MO",
            "license": "2000158538",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2633584",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "605711704",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIERBERGS FENTON CROSSING PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DIERBERGS FENTON CROSSING PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Diabetes Educator Registered Nurse in Fenton, MO
• Providers in Fenton, MO by specialty
• Diabetes Educator Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; 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.