Provider Demographics
NPI:1427160423
Name:ALAN C HONERKAMP INC
Entity type:Organization
Organization Name:ALAN C HONERKAMP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HONERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:636-949-5593
Mailing Address - Street 1:488 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:488 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2633
Practice Address - Country:US
Practice Address - Phone:636-949-5593
Practice Address - Fax:636-949-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
MO004195333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO621947001Medicaid
MO2620537OtherNCPDP #
2620537OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2620537OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MO2620537OtherNCPDP #