Organization · Type 2 NPI

Dedicated Missouri Holding, LLC

Non-Pharmacy Dispensing Site · St. Louis, MO

NPI number 1154968196 Active

Practice location

3721 S Grand Blvd
St. Louis, MO 63118-3405

Call (314) 328-0144 Map

Mailing address

1395 NW 167th St
Miami Gardens, FL 33169-5710

Specialties and licenses

Taxonomy	Code	License
Non-Pharmacy Dispensing Site Primary	332900000X	None listed

Non-Pharmacy Dispensing Site: A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

7 other providers at this address

Other non-pharmacy dispensing site providers in St. Louis

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NPI record

NPI: 1154968196
Entity type: Organization (Type 2)
Issued: Dec 10, 2019
Last updated: Mar 31, 2020
Status: Active
Subpart: Yes of Dedicated Missouri Holding, LLC

Other names

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Dedicated Senior Medical Center Tower Grove · doing business as

Authorized official

Mary Chen
Owner
(305) 628-6117

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1154968196

Dedicated Missouri Holding, LLC's National Provider Identifier is 1154968196, issued on Dec 10, 2019. The primary taxonomy on file is Non-Pharmacy Dispensing Site (332900000X), and the practice location is in St. Louis, MO. The record was last updated on Mar 31, 2020.