SSM Health Care St. Louis
Organization Active NPI Community/Retail Pharmacy · St. Chalres, MO
NPI 1164581526 · NPPES record last updated Oct 18, 2022
Key facts
- NPI
- 1164581526
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 005663 (MO)
- Legal business name
- SSM HEALTH CARE ST. LOUIS
- Practice address
- 711 Veterans Memorial Parkway Suite 102
St. Chalres, MO 63303-2106 - Phone
- (636) 669-2223
- Fax
- (636) 669-2222
- NPI assigned
- Dec 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Spencer
- Title
- V.P. Pharmacy Services
- Phone
- (314) 989-2588
Other NPIs on the same Medicare enrollment 4
Corporate family (same tax ID) 17
Practitioners 2
-
Ashley Glockner, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230509001911 | MO | Part B Supplier - Pharmacy | 7810800737 |
4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wentzville, MO; Saint Louis, MO; Saint Charles, MO; Bridgeton, MO |
National Provider Directory
- Tax ID family
- Eric S Colton MD
Locations
711 Veterans Memorial Pkwy
Ste 102
Saint Charles, MO 63303
Phone (636) 669-2200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 005663 | MO | Yes |
Addresses
Primary practice location
711 Veterans Memorial Parkway Suite 102
St. Chalres, MO 63303-2106
Mailing address
711 Veterans Memorial Parkway Suite 102
St. Charles, MO 63303
Phone (636) 443-2406
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2049385 | Other | PK | |
| 600284905 | Medicaid | MO |
Other names
- SSM Health Pharmacy
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.