Provider Demographics
NPI:1164904157
Name:NEIGHBORHOOD PHARMACY LLC
Entity Type:Organization
Organization Name:NEIGHBORHOOD PHARMACY LLC
Other - Org Name:KISMET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KRICHEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:314-390-1616
Mailing Address - Street 1:941 MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3038
Mailing Address - Country:US
Mailing Address - Phone:314-390-1616
Mailing Address - Fax:314-485-2347
Practice Address - Street 1:941 MIDLAND BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-3038
Practice Address - Country:US
Practice Address - Phone:314-390-1616
Practice Address - Fax:314-485-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO201802991333600000X, 3336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600061239Medicaid