Provider Demographics
NPI:1740781673
Name:SAI APOTHECARY LLC
Entity Type:Organization
Organization Name:SAI APOTHECARY LLC
Other - Org Name:EXCEL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KETA
Authorized Official - Middle Name:
Authorized Official - Last Name:JHALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-891-6967
Mailing Address - Street 1:505 SALT LICK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1288
Mailing Address - Country:US
Mailing Address - Phone:636-278-6561
Mailing Address - Fax:636-278-4754
Practice Address - Street 1:505 SALT LICK RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1288
Practice Address - Country:US
Practice Address - Phone:636-278-6561
Practice Address - Fax:636-278-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018005551333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy