Organization
INTRON LLC
Active
Other names
St Louis HIlls Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYLER TAYLOR PHARMD (OWNER)
(314) 832-2480
Entity
Organization
Contact information
Practice address
4365 CHIPPEWA ST STE 100, SAINT LOUIS, MO 63116-1606
(314) 832-2480
(314) 832-2498
Mailing address
4365 CHIPPEWA ST STE 100, SAINT LOUIS, MO 63116-1606
(314) 832-2480
(314) 832-2498
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
607137601
—
MO
Enumeration date
09/13/2017
Last updated
04/16/2023
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