1101A North Jefferson Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

1101A NORTH JEFFERSON PHARMACY LLC

Doing business as

Boca Pharmacy

Practice address

1101A N Jefferson Ave
Saint Louis, MO 63106-2222

Phone

(636) 242-8844

Fax

(636) 242-8822

NPI assigned

Jun 17, 2024

Last updated

Jun 17, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Sandra Jamron

Title

Managing Member

Phone

(636) 242-8844

Specialties & licenses 1

Addresses

Other names 1

• Boca Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1093558009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 S BEMISTON AVE STE 850",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631051920",
            "telephone_number": "636-242-8844",
            "fax_number": "636-242-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101A N JEFFERSON AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631062222",
            "telephone_number": "636-242-8844",
            "fax_number": "636-242-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1101A NORTH JEFFERSON PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "JAMRON",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "636-242-8844",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boca Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Providers in Saint Louis, MO by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.