=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295257053
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BHS PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2017
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 763 S NEW BALLAS RD STE 100
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-8711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-292-7388
-----------------------------------------------------
Fax | 314-292-7389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 763 S NEW BALLAS RD STE 100
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-8711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-292-7388
-----------------------------------------------------
Fax | 314-292-7389
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY IN CHARGE
-----------------------------------------------------
Name | MRS. NAVEEN RASHID KHAN
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 314-292-7388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 2017006390
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------