Healthcare Provider Details

I. General information

NPI: 1063118883
Provider Name (Legal Business Name): BWELL PHARMACY SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 10/10/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 CEDAR PLAZA PKWY STE 200
SAINT LOUIS MO
63128-3857
US

IV. Provider business mailing address

5000 CEDAR PLAZA PKWY STE 200
SAINT LOUIS MO
63128-3857
US

V. Phone/Fax

Practice location:
  • Phone: 314-527-1471
  • Fax:
Mailing address:
  • Phone: 314-527-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. SYED MUHAMMED HADI ZAIDI
Title or Position: OWNER
Credential:
Phone: 314-527-1471