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General NPI Number Information
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NPI Number | 1982438594
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Entity Type | Organization
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Legal Business Name | INTRON LLC
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Dates
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Enumeration Date | 08/27/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 4365 CHIPPEWA ST STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63116-1606
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Country | US
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Telephone | 314-832-2480
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Fax | 314-832-2498
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Provider Business Mailing Address
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Address Line | 4365 CHIPPEWA ST STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63116-1606
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Country | US
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Telephone | 314-832-2480
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Fax | 314-832-2498
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Authorized Official
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Title or Position | OWNER
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Name | DR. TYLER SUMNER TAYLOR
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Credential | PHARMD
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Telephone | 314-832-2480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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