Provider Demographics
NPI:1104953942
Name:F R HAEFNER INC
Entity type:Organization
Organization Name:F R HAEFNER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALPOAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-533-1081
Mailing Address - Street 1:11 N SARAH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2816
Mailing Address - Country:US
Mailing Address - Phone:314-533-1081
Mailing Address - Fax:314-533-1082
Practice Address - Street 1:11 N SARAH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2816
Practice Address - Country:US
Practice Address - Phone:314-533-1081
Practice Address - Fax:314-533-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X, 3336M0002X
MO0038433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO601370802Medicaid
2049445OtherPK
1272780001Medicare NSC