Provider Demographics
NPI:1013096510
Name:SSM HEALTH CARE ST LOUIS
Entity Type:Organization
Organization Name:SSM HEALTH CARE ST LOUIS
Other - Org Name:SSM HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-2588
Mailing Address - Street 1:10101 WOODFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2946
Mailing Address - Country:US
Mailing Address - Phone:314-994-7800
Mailing Address - Fax:
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-768-8870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTHCARE ST. LOUIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0053553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2627620OtherNCPDP NUMBER
MO5355OtherSTATE LICENSE
MO602252611Medicaid