Provider Demographics
NPI:1164581526
Name:SSM HEALTH CARE ST. LOUIS
Entity Type:Organization
Organization Name:SSM HEALTH CARE ST. LOUIS
Other - Org Name:SSM HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-2588
Mailing Address - Street 1:711 VETERANS MEMORIAL PARKWAY SUITE 102
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303
Mailing Address - Country:US
Mailing Address - Phone:636-443-2406
Mailing Address - Fax:636-669-2222
Practice Address - Street 1:711 VETERANS MEMORIAL PARKWAY SUITE 102
Practice Address - Street 2:
Practice Address - City:ST. CHALRES
Practice Address - State:MO
Practice Address - Zip Code:63303-2106
Practice Address - Country:US
Practice Address - Phone:636-669-2223
Practice Address - Fax:636-669-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO0056633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2049385OtherPK
MO600284905Medicaid