Provider Demographics
NPI:1063831287
Name:MERCY HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:MERCY HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER RETAIL PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-251-7445
Mailing Address - Street 1:1203 SMIZER MILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3483
Mailing Address - Country:US
Mailing Address - Phone:636-717-1491
Mailing Address - Fax:636-717-1492
Practice Address - Street 1:1203 SMIZER MILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3483
Practice Address - Country:US
Practice Address - Phone:636-717-1491
Practice Address - Fax:636-717-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy