Provider Demographics
NPI:1154893071
Name:LOCAL HEALTH SPECIALTY INC.
Entity type:Organization
Organization Name:LOCAL HEALTH SPECIALTY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-441-2036
Mailing Address - Street 1:330 N. FRANKLIN
Mailing Address - Street 2:PO BOX 528
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-6819
Mailing Address - Country:US
Mailing Address - Phone:573-885-0885
Mailing Address - Fax:573-677-0567
Practice Address - Street 1:522 N NEW BALLAS RD STE 206
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6819
Practice Address - Country:US
Practice Address - Phone:314-499-1227
Practice Address - Fax:314-499-1228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOCAL HEALTH SPECIALTY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-18
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600067557Medicaid