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General NPI Number Information
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NPI Number | 1609969880
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Entity Type | Organization
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Legal Business Name | SSM CARDINAL GLENNON CHILDRENS HOSPITAL
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 1465 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1003
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Country | US
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Telephone | 314-577-5683
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Fax | 314-268-4069
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Provider Business Mailing Address
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Address Line | 1465 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | V.P. PHARMACY SERVICES
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Name | KIMBERLY SPENCER
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Credential |
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Telephone | 314-989-2588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic 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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 006069
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License Number State | MO
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