NPIMap

Organization Active NPI

Dierbergs Markets Inc

Doing business as Dierbergs Southroads Pharmacy

  • Pharmacy
  • Saint Louis, MO
National Provider Identifier
1992894661
Registry record updated Apr 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
005302 Issued in MO
Legal business name
DIERBERGS MARKETS INC
Doing business as
Dierbergs Southroads Pharmacy
Practice address
12420 Tesson Ferry Rd
Saint Louis, MO 63128-2702
Phone
(314) 849-3880
Fax
(636) 530-3001
NPI assigned
Oct 12, 2006
Last updated
Apr 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2014

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

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 005302 MO Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

12420 Tesson Ferry Rd
Saint Louis, MO 63128-2702

Mailing address

PO Box 1070
Chesterfield, MO 63006-1070
Phone (636) 812-1470

Other identifiers 2

IdentifierTypeStateIssuer
2627531OtherOTHER ID NUMBER-COMMERCIAL NUMBER
603681404MedicaidMO

Other names 1

  • DIERBERGS SOUTHROADS PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

12420 Tesson Ferry Rd
Sappington, MO 63128
Phone (314) 849-3880

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396569600000",
    "number": "1992894661",
    "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": "12420 TESSON FERRY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282702",
            "telephone_number": "314-849-3880",
            "fax_number": "636-530-3001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIERBERGS MARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2014-04-04",
        "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": "MO",
            "license": "005302",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2627531",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "603681404",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIERBERGS SOUTHROADS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; 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.