Healthcare Provider Details

I. General information

NPI: 1356452155
Provider Name (Legal Business Name): ST MARYS HOLTS SUMMIT PHAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NORTHSTAR
HOLTS SUMMIT MO
65043
US

IV. Provider business mailing address

140 NORTHSTAR
HOLTS SUMMIT MO
65043
US

V. Phone/Fax

Practice location:
  • Phone: 573-896-4579
  • Fax: 573-896-4472
Mailing address:
  • Phone: 573-896-4579
  • Fax: 573-896-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2000143682
License Number StateMO

VIII. Authorized Official

Name: DR. JAMES RICHARD STEPP
Title or Position: DIRECTOR PHARMACY SERVICES
Credential: PHARMD
Phone: 573-681-3178