Provider Demographics
NPI:1003520586
Name:MERCY PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:MERCY PHARMACY SERVICES LLC
Other - Org Name:MERCY PHARMACY CRESTWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY REGULATORY COMPLIANCE MGR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-628-5627
Mailing Address - Street 1:14528 S OUTER 40 RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5785
Mailing Address - Country:US
Mailing Address - Phone:314-628-5627
Mailing Address - Fax:
Practice Address - Street 1:9555 WATSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:CRESTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63126
Practice Address - Country:US
Practice Address - Phone:314-628-5626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY PHARMACY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-10
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy