Provider Demographics
NPI:1689780595
Name:BARNES JEWISH ST PETERS HOSPITAL INC
Entity Type:Organization
Organization Name:BARNES JEWISH ST PETERS HOSPITAL INC
Other - Org Name:FAMILY CARE PHARMACY AT BARNES ST PETERS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:636-916-9473
Mailing Address - Street 1:6 JUNGERMANN CIR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 JUNGERMANN CIR
Practice Address - Street 2:SUITE 115
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1621
Practice Address - Country:US
Practice Address - Phone:636-916-9790
Practice Address - Fax:636-916-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19991381023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2632796OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MO604873703Medicaid