Healthcare Provider Details

I. General information

NPI: 1356796080
Provider Name (Legal Business Name): SJZ HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 E LOCKWOOD AVE
WEBSTER GROVES MO
63119-3219
US

IV. Provider business mailing address

608 E LOCKWOOD AVE
WEBSTER GROVES MO
63119-3219
US

V. Phone/Fax

Practice location:
  • Phone: 314-962-1065
  • Fax: 314-962-9215
Mailing address:
  • Phone: 314-962-1065
  • Fax: 314-962-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2016012058
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2158129
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier6001249407
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: STEVE ZIELINSKI
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 314-962-1065