MEDICARE: MERCY HEALTH SERVICES, 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
1	333600000X	Pharmacy	2005000851	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2635881	OTHER	MO	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689665077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	12680 OLIVE BLVD
Second Line	:	SUITE #150
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6322
Country	:	US
Telephone Number	:	314-251-8989
Fax Number	:	314-251-8988

Provider Business Practice Location Address
First Line	:	12680 OLIVE BLVD
Second Line	:	SUITE #150
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6322
Country	:	US
Telephone Number	:	314-251-8989
Fax Number	:	314-251-8988

Authorized Official
Title or Position	:	EXEC DIR-RETAIL PHARMACY SVCS
Name	:	PATRICK BERRY
Credential	:
Telephone Number	:	314-628-5606

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	11/10/2017

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Directions to “MERCY HEALTH SERVICES, LLC ” Practice Location

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