Healthcare Provider Details

I. General information

NPI: 1780460238
Provider Name (Legal Business Name): BWELL PHARMACY SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 10/04/2023
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: 314-292-7388
  • Fax: 314-467-4988
Mailing address:
  • Phone: 314-292-7388
  • Fax: 314-467-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NAVEEN KHAN
Title or Position: PHARMACIST IN CHARGE
Credential: RPH.
Phone: 314-292-7388