Healthcare Provider Details

I. General information

NPI: 1548264591
Provider Name (Legal Business Name): EVERSANA LIFE SCIENCE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17877 CHESTERFIELD AIRPORT RD
CHESTERFIELD MO
63005-1211
US

IV. Provider business mailing address

17877 CHESTERFIELD AIRPORT RD
CHESTERFIELD MO
63005-1211
US

V. Phone/Fax

Practice location:
  • Phone: 636-519-2400
  • Fax: 877-473-3172
Mailing address:
  • Phone: 866-849-4481
  • Fax: 877-473-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2014000185
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number2014000185
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JORGE RESTREPO
Title or Position: DIRECTOR ACCESS AND REIMBURSEMENT
Credential:
Phone: 513-285-1889