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NPI Code Detail

MEDICARE: SPECIALTY PHARMACY OF ST. LOUIS, LLC

MEDICARE: SPECIALTY PHARMACY OF ST. LOUIS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336S0011XSpecialty Pharmacy2003001140MO
23336C0004XCompounding Pharmacy2003001140MO

General Provider Information

NPI Number : 1194917773
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECIALTY PHARMACY OF ST. LOUIS, LLC
Provider Business Mailing Address
First Line : 623 N NEW BALLAS RD
Second Line :
City : CREVE COEUR
State : MO
Zip : 63141-6713
Country : US
Telephone Number : 314-991-5200
Fax Number : 314-991-5210
Provider Business Practice Location Address
First Line : 623 N NEW BALLAS RD
Second Line :
City : CREVE COEUR
State : MO
Zip : 63141-6713
Country : US
Telephone Number : 314-991-5200
Fax Number : 314-991-5210
Authorized Official
Title or Position : PRESIDENT
Name : DR. LEE ERIC ORI
Credential : PHARMD
Telephone Number : 314-991-5200
Provider Enumeration Date : 08/16/2007
Last Update Date : 08/16/2007

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