ST. LOUIS PHARMACY-JB DIVISION (2864)    INSTITUTION (4)

Name Value
NAME ST. LOUIS PHARMACY-JB DIVISION
STATE MISSOURI
STREET ADDR. 1 #1 Jefferson Barracks Dr.
CITY St. Louis
ZIP 63125-4181
OFFICIAL VA NAME St. Louis Pharmacy-JB Division
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME ST. LOUIS JB VAMC PHARMACY
ST. ADDR. 1 (MAILING) #1 Jefferson Barracks Dr.
CITY (MAILING) St. Louis
STATE (MAILING) MISSOURI
ZIP (MAILING) 63125-4181
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1558319715
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE CENTRAL
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1558319715