Healthcare Provider Details

I. General information

NPI: 1154878783
Provider Name (Legal Business Name): LSL-RX, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 POND FORT TRL
LAKE ST LOUIS MO
63367-4022
US

IV. Provider business mailing address

356 LARIMORE VALLEY DR
WILDWOOD MO
63005-6225
US

V. Phone/Fax

Practice location:
  • Phone: 314-440-7565
  • Fax:
Mailing address:
  • Phone: 314-882-3123
  • 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: JENNIFER CARROLL
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 314-440-7565