MEDICARE: BWELL 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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy

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

General Provider Information

NPI Number	:	1932588514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BWELL PHARMACY LLC

Provider Business Mailing Address
First Line	:	5201 CHIPPEWA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2355
Country	:	US
Telephone Number	:	314-328-1100
Fax Number	:	314-328-1101

Provider Business Practice Location Address
First Line	:	5201 CHIPPEWA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2355
Country	:	US
Telephone Number	:	314-328-1100
Fax Number	:	314-328-1101

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. FATIMA HAIDER
Credential	:
Telephone Number	:	314-328-1100

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	11/15/2021

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Directions to “BWELL PHARMACY LLC ” Practice Location

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