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NPI Code Detail

MEDICARE: BLINK HEALTH PHARMACY LLC

MEDICARE: BLINK HEALTH PHARMACY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy2018011541MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12018011541OTHERMOMISSOURI BOARD OF PHARMACY

General Provider Information

NPI Number : 1063919710
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLINK HEALTH PHARMACY LLC
Provider Business Mailing Address
First Line : 400 S WOODS MILL RD STE 100
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63017-3427
Country : US
Telephone Number : 314-356-2943
Fax Number : 314-558-2641
Provider Business Practice Location Address
First Line : 400 S WOODS MILL RD STE 100
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63017-3427
Country : US
Telephone Number : 314-356-2943
Fax Number : 314-558-2641
Authorized Official
Title or Position : EVP, PHARMACY
Name : MICHAEL NAMETH
Credential :
Telephone Number : 412-266-5515
Provider Enumeration Date : 04/10/2018
Last Update Date : 10/25/2024

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