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General NPI Number Information
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NPI Number | 1194917773
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Entity Type | Organization
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Legal Business Name | SPECIALTY PHARMACY OF ST. LOUIS, LLC
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 623 N NEW BALLAS RD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6713
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Country | US
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Telephone | 314-991-5200
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Fax | 314-991-5210
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Provider Business Mailing Address
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Address Line | 623 N NEW BALLAS RD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6713
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Country | US
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Telephone | 314-991-5200
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Fax | 314-991-5210
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEE ERIC ORI
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Credential | PHARMD
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Telephone | 314-991-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 2003001140
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 2003001140
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License Number State | MO
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