Healthcare Provider Details

I. General information

NPI: 1053010066
Provider Name (Legal Business Name): LINDBERGH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLAGE SQUARE SHOP CTR
HAZELWOOD MO
63042
US

IV. Provider business mailing address

1727 COACHWAY LN
HAZELWOOD MO
63042-1379
US

V. Phone/Fax

Practice location:
  • Phone: 314-281-3583
  • Fax:
Mailing address:
  • Phone: 314-281-3583
  • 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: SAMER ISSA
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 314-281-3583