Healthcare Provider Details

I. General information

NPI: 1912216441
Provider Name (Legal Business Name): ALEXIAN BROTHERS COMM SVCS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 S GRAND BLVD
SAINT LOUIS MO
63118-3414
US

IV. Provider business mailing address

3900 S GRAND BLVD
SAINT LOUIS MO
63118-3414
US

V. Phone/Fax

Practice location:
  • Phone: 314-771-5800
  • Fax: 314-771-6819
Mailing address:
  • Phone: 314-771-5800
  • Fax: 314-771-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number006607
License Number StateMO

VIII. Authorized Official

Name: ALFREDA PULLEY
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 314-771-5800