MEDICARE: BETHESDA SERVICES, INC

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
1	333600000X	Pharmacy	001763	MO

General Provider Information

NPI Number	:	1649246851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA SERVICES, INC

Provider Business Mailing Address
First Line	:	1630 DES PERES RD
Second Line	:	STE 290
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1800
Country	:	US
Telephone Number	:	314-800-1900
Fax Number	:	314-800-1961

Provider Business Practice Location Address
First Line	:	21 N OLD ORCHARD AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2699
Country	:	US
Telephone Number	:	314-961-0604
Fax Number	:	314-961-1505

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	MR. JOSEPH J BRINKER
Credential	:
Telephone Number	:	314-800-1988

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	08/22/2020

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