Organization
BWELL PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FATIMA HAIDER (OWNER)
(314) 328-1100
Entity
Organization
Contact information
Practice address
5201 CHIPPEWA ST, SAINT LOUIS, MO 63109-2355
(314) 328-1100
(314) 328-1101
Mailing address
5201 CHIPPEWA ST, SAINT LOUIS, MO 63109-2355
(314) 328-1100
(314) 328-1101
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932588514
—
MO
Enumeration date
05/28/2015
Last updated
11/15/2021
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