Provider Demographics
NPI:1104249168
Name:OLIVE STREET PHARMACY LLC
Entity type:Organization
Organization Name:OLIVE STREET PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHLAFSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-736-5555
Mailing Address - Street 1:10420 OLD OLIVE STREET RD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5914
Mailing Address - Country:US
Mailing Address - Phone:314-736-5555
Mailing Address - Fax:314-736-5500
Practice Address - Street 1:10420 OLD OLIVE STREET RD STE 103
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5937
Practice Address - Country:US
Practice Address - Phone:314-736-5555
Practice Address - Fax:314-736-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy