MEDICARE: PHARMALOOP

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336L0003X	Long Term Care Pharmacy
5	3336C0003X	Community/Retail Pharmacy	2015038822	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2155458	OTHER		PK

General Provider Information

NPI Number	:	1932573565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMALOOP

Provider Business Mailing Address
First Line	:	3229 LEMAY FERRY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-4419
Country	:	US
Telephone Number	:	314-200-6500
Fax Number	:	314-529-1717

Provider Business Practice Location Address
First Line	:	3229 LEMAY FERRY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-4419
Country	:	US
Telephone Number	:	314-200-6500
Fax Number	:	314-529-1717

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	DR. YERVAND SIMONYAN
Credential	:	PHARMD
Telephone Number	:	314-200-6500

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	03/09/2022

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Directions to “PHARMALOOP ” Practice Location

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