MEDICARE: MERCY PHARMACY SERVICES 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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1255925780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY PHARMACY SERVICES LLC

Provider Business Mailing Address
First Line	:	14528 S OUTER 40 RD STE 100
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-5743
Country	:	US
Telephone Number	:	314-628-5627
Fax Number	:	636-530-3005

Provider Business Practice Location Address
First Line	:	11481 OLIVE BLVD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7184
Country	:	US
Telephone Number	:	314-432-5708
Fax Number	:	636-530-3005

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DOUG MALCOLM
Credential	:	PHARMD, MHA
Telephone Number	:	303-813-5532

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	01/26/2026

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