Provider Demographics
NPI:1467488056
Name:CHRISTOPHER M GERONSIN INC.
Entity Type:Organization
Organization Name:CHRISTOPHER M GERONSIN INC.
Other - Org Name:BEVERLY HILLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERONSIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-381-8600
Mailing Address - Street 1:7150 NATURAL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-5151
Mailing Address - Country:US
Mailing Address - Phone:314-381-8600
Mailing Address - Fax:314-381-6844
Practice Address - Street 1:7150 NATURAL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-5151
Practice Address - Country:US
Practice Address - Phone:314-381-8600
Practice Address - Fax:314-381-6844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0297033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO620201202Medicaid
MO600201206Medicaid
MO620201202Medicaid
MO0163530001Medicare NSC