Provider Demographics
NPI:1053373985
Name:MACKE, ALAN DEAN (RPH)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DEAN
Last Name:MACKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:441 WOODBINE CT
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-3635
Mailing Address - Country:US
Mailing Address - Phone:636-282-2508
Mailing Address - Fax:314-894-5731
Practice Address - Street 1:1 JEFFERSON BARRACKS DR
Practice Address - Street 2:119-JB
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4181
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:314-894-5731
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist