Provider Demographics
NPI:1235245143
Name:MISSOURI BAPTIST MED CNTR FMLY CRE PHRMCY SUNSET HILLS
Entity Type:Organization
Organization Name:MISSOURI BAPTIST MED CNTR FMLY CRE PHRMCY SUNSET HILLS
Other - Org Name:FAMILY CARE PHARMACY SSH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUENTHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-525-0415
Mailing Address - Street 1:3844 S LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1368
Mailing Address - Country:US
Mailing Address - Phone:314-525-0415
Mailing Address - Fax:
Practice Address - Street 1:3844 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1368
Practice Address - Country:US
Practice Address - Phone:314-525-0415
Practice Address - Fax:314-525-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20030021333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2619166OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2619166OtherOTHER ID NUMBER
MO1019230002Medicare NSC