Healthcare Provider Details

I. General information

NPI: 1861483232
Provider Name (Legal Business Name): ST LUKES EPISCOPAL PRESBYTERIAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S WOODS MILL RD STE 350
CHESTERFIELD MO
63017-3513
US

IV. Provider business mailing address

224 S WOODS MILL RD STE 350
CHESTERFIELD MO
63017-3513
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6023
  • Fax: 314-205-6496
Mailing address:
  • Phone: 314-205-6023
  • Fax: 314-205-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2008006745
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RICHARD FOOK
Title or Position: PHCY DIRECTOR
Credential:
Phone: 314-205-6291