Provider Demographics
NPI:1841231743
Name:ST LOUIS CONNECTCARE DR SMILEY PHCY
Entity Type:Organization
Organization Name:ST LOUIS CONNECTCARE DR SMILEY PHCY
Other - Org Name:DR SMILEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR PHCY
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-879-6232
Mailing Address - Street 1:5535 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5535 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3005
Practice Address - Country:US
Practice Address - Phone:314-879-6214
Practice Address - Fax:314-879-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005036004333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2636340OtherOTHER ID NUMBER-COMMERCIAL NUMBER