Organization
SPECIALTY RETAIL PHARMACY
Active
Other names
SPECIALTY RETAIL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LEE ORI PHRMD (PRESIDENT)
(314) 991-5200
Entity
Organization
Contact information
Practice address
623 N NEW BALLAS RD, STE B, SAINT LOUIS, MO 63141-6713
(314) 991-5200
(314) 991-5210
Mailing address
623 N NEW BALLAS RD, STE B, SAINT LOUIS, MO 63141-6713
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2007037394
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2637809
OTHER ID NUMBER
—
Enumeration date
05/16/2008
Last updated
05/16/2008
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