Organization · NPI-2
1101a North Jefferson Pharmacy LLC
Pharmacy, Long Term Care Pharmacy · Saint Louis, MO
NPI number1093558009
StatusActive
Last updated in NPPESJun 17, 2024
Details
- NPI
- 1093558009
- Entity type
- Organization (NPI-2)
- Legal business name
- 1101a North Jefferson Pharmacy LLC
- Organization subpart
- No
- Enumeration date
- Jun 17, 2024
- Certification date
- Jun 17, 2024
- Last updated
- Jun 17, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336L0003X | Pharmacy, Long Term Care Pharmacy | – | – | Yes |
Other names
- Boca Pharmacy (Doing Business As)
Practice location
1101a N Jefferson AveSaint Louis, MO 63106-2222
Phone 636-242-8844 · Fax 636-242-8822
Mailing address
231 S Bemiston Ave Ste 850Saint Louis, MO 63105-1920
Phone 636-242-8844 · Fax 636-242-8822
Authorized official
Sandra Jamron
Managing Member
6362428844
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