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General NPI Number Information
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NPI Number | 1053357566
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Entity Type | Organization
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Legal Business Name | ST ANTHONYS PROFESSIONAL PHARMACY LLC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 10004 KENNERLY RD SUITE 130
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2141
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Country | US
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Telephone | 314-525-4777
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Fax | 314-525-4642
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Provider Business Mailing Address
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Address Line | 12700 SOUTHFORK RD SUITE 110
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3201
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Country | US
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Telephone | 314-525-4488
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Fax | 314-525-4810
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Authorized Official
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Title or Position | CFO
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Name | KEN VENUTO
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Credential | RPH
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Telephone | 314-525-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2000160057
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License Number State | MO
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