Healthcare Provider Details

I. General information

NPI: 1346325032
Provider Name (Legal Business Name): MERCY HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13185 LAKEFRONT DR SUITE 120
EARTH CITY MO
63045-1510
US

IV. Provider business mailing address

13185 LAKEFRONT DR SUITE 120
EARTH CITY MO
63045-1510
US

V. Phone/Fax

Practice location:
  • Phone: 314-506-6050
  • Fax: 314-506-6284
Mailing address:
  • Phone: 314-506-6050
  • Fax: 314-506-6284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number006006
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number006006
License Number StateMO

VIII. Authorized Official

Name: MR. ROBERT DENNIS STREET
Title or Position: PHARMACST-IN-CHARGE
Credential: MBA, RPH
Phone: 314-506-6149