Healthcare Provider Details

I. General information

NPI: 1932588514
Provider Name (Legal Business Name): BWELL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 CHIPPEWA ST
SAINT LOUIS MO
63109-2355
US

IV. Provider business mailing address

5201 CHIPPEWA ST
SAINT LOUIS MO
63109-2355
US

V. Phone/Fax

Practice location:
  • Phone: 314-328-1100
  • Fax: 314-328-1101
Mailing address:
  • Phone: 314-328-1100
  • Fax: 314-328-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. FATIMA HAIDER
Title or Position: OWNER
Credential:
Phone: 314-328-1100