MEDICARE: SYB GROUP 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	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	2002009522	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2627442	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437264470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYB GROUP LLC

Provider Business Mailing Address
First Line	:	4900 DELMAR BLVD STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1615
Country	:	US
Telephone Number	:	314-367-3009
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 DELMAR BLVD STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1615
Country	:	US
Telephone Number	:	314-367-3009
Fax Number	:	314-367-7792

Authorized Official
Title or Position	:	OWNER
Name	:	SAM BAE
Credential	:	BS PHARMACY
Telephone Number	:	314-367-3009

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	03/17/2018

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Directions to “SYB GROUP LLC ” Practice Location

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