Provider Demographics
NPI:1437264470
Name:SYB GROUP LLC
Entity Type:Organization
Organization Name:SYB GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:314-367-3009
Mailing Address - Street 1:4900 DELMAR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1615
Mailing Address - Country:US
Mailing Address - Phone:314-367-3009
Mailing Address - Fax:
Practice Address - Street 1:4900 DELMAR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1615
Practice Address - Country:US
Practice Address - Phone:314-367-3009
Practice Address - Fax:314-367-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
MO20020095223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2627442OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MO602964801Medicaid
2627442OtherNCPDP PROVIDER IDENTIFICATION NUMBER