MEDICARE: LIN-KRIS PHARMACY INC

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	3336L0003X	Long Term Care Pharmacy
3	3336C0004X	Compounding Pharmacy
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	3336C0003X	Community/Retail Pharmacy	003766	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2051554	OTHER		PK

General Provider Information

NPI Number	:	1578580304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIN-KRIS PHARMACY INC

Provider Business Mailing Address
First Line	:	4221 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7513
Country	:	US
Telephone Number	:	314-638-1000
Fax Number	:	314-638-8430

Provider Business Practice Location Address
First Line	:	4221 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7513
Country	:	US
Telephone Number	:	314-638-1000
Fax Number	:	314-638-8430

Authorized Official
Title or Position	:	PRES OWNER
Name	:	ROY EBERHART
Credential	:	RPH
Telephone Number	:	314-795-8426

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	06/01/2015

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