NPIMap

Organization Active NPI

Dierbergs Town Center Pharmacy

  • Pharmacy
  • Wildwood, MO
National Provider Identifier
1710359484
Registry record updated Oct 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
2003031656 Issued in MO
Legal business name
DIERBERGS TOWN CENTER PHARMACY
Practice address
2460 Taylor Road
Wildwood, MO 63040
Phone
(636) 458-7450
NPI assigned
Oct 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2015

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

Authorized official

Name
Mrs. Brenda McDaniel
Title
Staff Pharmacist
Phone
(636) 458-7450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 2003031656 MO Primary

Addresses

Primary practice location

2460 Taylor Road
Wildwood, MO 63040

Mailing address

2460 Taylor Road
Wildwood, MO 63040
Phone (636) 458-7450

Other identifiers 1

IdentifierTypeStateIssuer
606120103MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
Dierbergs Markets Incorporated2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445385600000",
    "number": "1710359484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 TAYLOR ROAD",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "63040",
            "telephone_number": "636-458-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 TAYLOR ROAD",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "63040",
            "telephone_number": "636-458-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIERBERGS TOWN CENTER PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-21",
        "last_updated": "2015-10-21",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "STAFF PHARMACIST",
        "authorized_official_telephone_number": "636-458-7450",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MO",
            "license": "2003031656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606120103",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildwood, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; 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.