Olive Street Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

OLIVE STREET PHARMACY LLC

Practice address

10420 Old Olive Street Rd Ste 103
Creve Coeur, MO 63141-5937

Phone

(314) 736-5555

Fax

(314) 736-5500

NPI assigned

Jan 28, 2014

Organization subpart

No

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

Authorized official

Name

Alexander Shlafshteyn

Title

Member

Phone

(314) 736-5555

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vadim Yuri Baram, MD

  • Psychiatry Physician
  • Saint Louis, MO
  • NPI 1124007380
  NPD (past)
• Clayton Nelson Brown

  • Pharmacist
  • Creve Coeur, MO
  • NPI 1144629064
  NPD (past)

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

{
    "created_epoch": "1390867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640822400000",
    "number": "1104249168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10420 OLD OLIVE STREET RD",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631415914",
            "telephone_number": "314-736-5555",
            "fax_number": "314-736-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10420 OLD OLIVE STREET RD STE 103",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631415937",
            "telephone_number": "314-736-5555",
            "fax_number": "314-736-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE STREET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-28",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A",
        "authorized_official_last_name": "SHLAFSHTEYN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "314-736-5555"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Obholz, OT
• Michael John Oconnell, DMD LLC
• Olde Cabin Anesthesia
• Olive Ambulatory Surgery Center, LLC
• Olive Ambulatory Surgery Center, LLC
• Olive Surgery Center
• Thomas V Olivier, MD
• Onyx Spine and Orthopedic Ambulatory Surgery Center LLC
• Opensided MRI of St Louis II
• Opensided MRI of St Louis, LLC

• Pharmacy in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; 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.