Organization
SYB GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM BAE BS PHARMACY (OWNER)
(314) 367-3009
Entity
Organization
Contact information
Practice address
4900 DELMAR BLVD STE 200, SAINT LOUIS, MO 63108-1615
(314) 367-3009
(314) 367-7792
Mailing address
4900 DELMAR BLVD STE 200, SAINT LOUIS, MO 63108-1615
(314) 367-3009
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2002009522
MO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2627442
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
602964801
—
MO
Enumeration date
08/20/2006
Last updated
03/17/2018
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