Provider Demographics
NPI:1851436489
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:OWNER
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 ROAD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-278-6561
Mailing Address - Fax:636-278-4754
Practice Address - Street 1:505 SALT LICK ROAD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
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:2007-02-21
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO057903336C0003X
MO20180055513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600309900Medicaid
2613506OtherOTHER ID NUMBER-COMMERCIAL NUMBER