Healthcare Provider Details

I. General information

NPI: 1326567157
Provider Name (Legal Business Name): INTRON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 04/16/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 CHIPPEWA ST STE 100
SAINT LOUIS MO
63116-1606
US

IV. Provider business mailing address

4365 CHIPPEWA ST STE 100
SAINT LOUIS MO
63116-1606
US

V. Phone/Fax

Practice location:
  • Phone: 314-832-2480
  • Fax: 314-832-2498
Mailing address:
  • Phone: 314-832-2480
  • Fax: 314-832-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. TYLER TAYLOR
Title or Position: OWNER
Credential: PHARMD
Phone: 314-832-2480