Healthcare Provider Details

I. General information

NPI: 1437264470
Provider Name (Legal Business Name): SYB GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 DELMAR BLVD STE 200
SAINT LOUIS MO
63108-1615
US

IV. Provider business mailing address

4900 DELMAR BLVD STE 200
SAINT LOUIS MO
63108-1615
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-3009
  • Fax: 314-367-7792
Mailing address:
  • Phone: 314-367-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2002009522
License Number StateMO

VIII. Authorized Official

Name: SAM BAE
Title or Position: OWNER
Credential: BS PHARMACY
Phone: 314-367-3009