Organization
STATE OF MISSOURI
Active
Parent organization
STATE OF MISSOURI
Other names
Metropolitan SL PC Pharmcy
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF MISSOURI
Authorized official
MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES)
(573) 751-4055
Entity
Organization
Contact information
Practice address
5351 DELMAR BLVD, SAINT LOUIS, MO 63112-3146
(314) 877-0663
(314) 877-0662
Mailing address
1706 E ELM ST, JEFFERSON CITY, MO 65101-4130
(573) 751-3398
(573) 526-4560
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2636364
NCPDP
—
Enumeration date
02/05/2007
Last updated
10/27/2020
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