Provider Demographics
NPI:1760486781
Name:M.D. PHARMACY INC
Entity type:Organization
Organization Name:M.D. PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO - MD PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORDES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:314-991-1111
Mailing Address - Street 1:8500 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2111
Mailing Address - Country:US
Mailing Address - Phone:314-991-1111
Mailing Address - Fax:314-991-2338
Practice Address - Street 1:8390 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63124-2117
Practice Address - Country:US
Practice Address - Phone:314-991-1111
Practice Address - Fax:314-991-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO023373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO02337OtherMO. BOARD
MO2612237OtherNABP
MO602629206Medicaid
MO602629206Medicaid
MO0154200001Medicare NSC