Healthcare Provider Details

I. General information

NPI: 1700863180
Provider Name (Legal Business Name): FAMILY CARE HEALTH CENTERS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOLLY HILLS AVE
SAINT LOUIS MO
63111-2410
US

IV. Provider business mailing address

401 HOLLY HILLS AVE
SAINT LOUIS MO
63111-2410
US

V. Phone/Fax

Practice location:
  • Phone: 314-481-1615
  • Fax: 314-353-1310
Mailing address:
  • Phone: 314-481-1615
  • Fax: 314-353-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2003004144
License Number StateMO

VIII. Authorized Official

Name: ROBIN S JONES
Title or Position: CFO
Credential:
Phone: 314-481-1615