Provider Demographics
NPI:1356796080
Name:SJZ HEALTHCARE
Entity type:Organization
Organization Name:SJZ HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIELINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-962-1065
Mailing Address - Street 1:608 E LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3219
Mailing Address - Country:US
Mailing Address - Phone:314-962-1065
Mailing Address - Fax:314-962-9215
Practice Address - Street 1:608 E LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-3219
Practice Address - Country:US
Practice Address - Phone:314-962-1065
Practice Address - Fax:314-962-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X
MO20160120583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158129OtherPK
MO6001249407Medicaid