=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689780595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARNES JEWISH ST PETERS HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 10/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 JUNGERMANN CIR SUITE 115
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-916-9790
-----------------------------------------------------
Fax | 636-916-9714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 JUNGERMANN CIR SUITE 115
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | DARRELL BIRCH
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 636-916-9473
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 1999138102
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------