Basic Information
| Provider Information | |||||||||
| NPI: | 1083206486 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERCY PHARMACY SERVICES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MERCY PHARMACY BRENTWOOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8450 EAGER RD | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631441413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149629036 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8450 EAGER RD | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631441413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149629036 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2021 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LAKAMP | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF PHARMACY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3146283406 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.