Provider Demographics
NPI:1194823195
Name:WASHINGTON UNIVERSITY
Entity Type:Organization
Organization Name:WASHINGTON UNIVERSITY
Other - Org Name:WASHINGTON UNIVERSITY CANCER CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-747-2472
Mailing Address - Street 1:4921 PARKVIEW PLACE
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-362-7356
Mailing Address - Fax:314-747-4579
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:7TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-8646
Practice Address - Fax:314-747-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO0053103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2049517OtherPK
MO606351708Medicaid
0255860007Medicare NSC