Healthcare Provider Details

I. General information

NPI: 1528717782
Provider Name (Legal Business Name): BJC BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: BJC BEHAVIORAL HEALTH PHARMACY

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 GRAHAM RD STE 102
FLORISSANT MO
63031-8077
US

IV. Provider business mailing address

1430 OLIVE ST STE 500
SAINT LOUIS MO
63103-2377
US

V. Phone/Fax

Practice location:
  • Phone: 314-657-9010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANGELA MARTIN-DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 314-206-3712