Provider Demographics
NPI:1356452155
Name:ST MARYS HOLTS SUMMIT PHAR
Entity Type:Organization
Organization Name:ST MARYS HOLTS SUMMIT PHAR
Other - Org Name:SSM HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHARMACY SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:STEPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:573-681-3178
Mailing Address - Street 1:140 NORTHSTAR
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043
Mailing Address - Country:US
Mailing Address - Phone:573-896-4579
Mailing Address - Fax:573-896-4472
Practice Address - Street 1:140 NORTHSTAR
Practice Address - Street 2:
Practice Address - City:HOLTS SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:65043
Practice Address - Country:US
Practice Address - Phone:573-896-4579
Practice Address - Fax:573-896-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001436823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO607727807Medicaid
2629321OtherNCPDP