Healthcare Provider Details

I. General information

NPI: 1851436489
Provider Name (Legal Business Name): SAI APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SALT LICK ROAD
SAINT PETERS MO
63376
US

IV. Provider business mailing address

505 SALT LICK ROAD
SAINT PETERS MO
63376
US

V. Phone/Fax

Practice location:
  • Phone: 636-278-6561
  • Fax: 636-278-4754
Mailing address:
  • Phone: 636-278-6561
  • Fax: 636-278-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05790
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2018005551
License Number StateMO

VIII. Authorized Official

Name: KETA JHALA
Title or Position: OWNER
Credential:
Phone: 817-891-6967