Provider Demographics
NPI:1427640820
Name:MERCY PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:MERCY PHARMACY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-628-3406
Mailing Address - Street 1:6671 EDWARDSVILLE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2704
Mailing Address - Country:US
Mailing Address - Phone:618-307-3817
Mailing Address - Fax:618-307-3816
Practice Address - Street 1:6671 EDWARDSVILLE CROSSING DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2704
Practice Address - Country:US
Practice Address - Phone:618-307-3817
Practice Address - Fax:618-307-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy