=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649751744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LSCS HOLDINGS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2018
-----------------------------------------------------
Last Update Date | 08/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17877 CHESTERFIELD AIRPORT RD
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63005-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-519-2496
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 444 W LAKE ST STE 1800
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60606-0096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-519-2496
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, CONTRACTING AND PAYER ACCESS
-----------------------------------------------------
Name | BRIAN D DAVIS
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 636-519-2496
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------