Provider Demographics
NPI: | 1760074173 |
---|---|
Name: | MERCY PHARMACY SERVICES LLC |
Entity Type: | Organization |
Organization Name: | MERCY PHARMACY SERVICES LLC |
Other - Org Name: | MERCY PHARMACY MACKENZIE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF PHARMACY OFFCIER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JONATHAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LAKAMP |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 314-628-3406 |
Mailing Address - Street 1: | 7233 WATSON RD |
Mailing Address - Street 2: | |
Mailing Address - City: | WEBSTER GROVES |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 63119-4401 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 314-752-7881 |
Mailing Address - Fax: | 636-530-3013 |
Practice Address - Street 1: | 7233 WATSON RD |
Practice Address - Street 2: | |
Practice Address - City: | WEBSTER GROVES |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63119-4401 |
Practice Address - Country: | US |
Practice Address - Phone: | 314-752-7881 |
Practice Address - Fax: | 636-530-3013 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-02-07 |
Last Update Date: | 2021-02-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
No | 333600000X | Suppliers | Pharmacy |