Provider Demographics
NPI:1326124389
Name:ST. JOHN'S MERCY MEDSCRIPT, INC.
Entity Type:Organization
Organization Name:ST. JOHN'S MERCY MEDSCRIPT, INC.
Other - Org Name:MEDSCRIPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-729-4668
Mailing Address - Street 1:13185 LAKEFRONT DR
Mailing Address - Street 2:
Mailing Address - City:EARTH CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63045-1510
Mailing Address - Country:US
Mailing Address - Phone:314-506-6066
Mailing Address - Fax:
Practice Address - Street 1:13185 LAKEFRONT DR
Practice Address - Street 2:
Practice Address - City:EARTH CITY
Practice Address - State:MO
Practice Address - Zip Code:63045-1510
Practice Address - Country:US
Practice Address - Phone:314-506-6066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0660310001Medicare NSC