Healthcare Provider Details

I. General information

NPI: 1316908403
Provider Name (Legal Business Name): MERCY HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S NEW BALLAS RD SUITE 1415
SAINT LOUIS MO
63141-8219
US

IV. Provider business mailing address

607 S NEW BALLAS RD SUITE 1415
SAINT LOUIS MO
63141-8219
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-5478
  • Fax: 314-251-6375
Mailing address:
  • Phone: 314-251-5478
  • Fax: 314-251-6375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberR4C88
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number2014005811
License Number StateMO

VIII. Authorized Official

Name: MR. PATRICK BERRY
Title or Position: EXEC DIR-RETAIL PHARMACY SVCS
Credential:
Phone: 314-628-5606