ST. LOUIS JC VAMC (NPI# 1588622880) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588622880 |
| Entity Type | Organization |
| Organization Name | ST. LOUIS JC VAMC |
| Other Organization Name | POPLAR BLUFF VAMC PHARMACY |
| Practice Address |
1500 N Westwood Blvd Poplar Bluff MO 63901-3318 |
| Mailing Address |
Po Box 94462 Cleveland OH 44101-4462 |
| Practice Telephone | 5737784245 |
| Practice Fax Number | 5737784246 |
| Mailing Telephone | 9135784409 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2018-10-23 |
| Authorized Official Name | ERIN DENISE POTTER (NPI TEAM MEMBER) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332100000X | Department of Veterans Affairs (VA) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | NCPDP# | 2616805 | 01 |
| Other Name | Type Code |
|---|---|
| POPLAR BLUFF VAMC PHARMACY | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114317369 | St. Louis Jc Vamc | Clinic/Center | 2600 Washington Boulevard, St. Louis, MO 63103-1420 | 2015-01-27 |
| 1396135513 | St. Louis Jc Vamc | Clinic/Center | 3615 Olive Street, St. Louis, MO 63108-3604 | 2015-01-26 |
| 1558751776 | St. Louis Jc Vamc | Clinic/Center | 3403 Heartland Street, Marion, IL 62959-6393 | 2015-01-26 |
| 1992067995 | St. Louis Jc Vamc | Clinic/Center | 1130 E Walnut St, Suite 100, Carbondale, IL 62901-5007 | 2012-06-14 |
| 1497012652 | St. Louis Jc Vamc | Clinic/Center | 608 Rollie Moore Drive, Harrisburg, IL 62946-9998 | 2012-04-12 |
| 1902198922 | St. Louis Jc Vamc | Clinic/Center | 1627 A Roy Dr, Washington, MO 63090-5008 | 2011-05-10 |
| 1619116399 | St. Louis Jc Vamc | Clinic/Center | 1253 Paris Rd, Suite A, Mayfield, KY 42066-4989 | 2009-02-19 |
| 1518155878 | St. Louis Jc Vamc | Clinic/Center | 6854 Parker Rd, Florissant, MO 63033-5313 | 2007-10-11 |
| 1578616892 | St. Louis Jc Vamc | Clinic/Center | 99 Stagecoach Rd, Madisonville, KY 42431-8009 | 2007-01-19 |
| 1902840622 | St. Louis Jc Vamc | Clinic/Center | 4105 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2006-06-15 |
| Street Address |
1500 N WESTWOOD BLVD |
| City | POPLAR BLUFF |
| State | MO |
| Zip Code | 63901-3318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336142256 | Jeffrey Lee Dakas | Internal Medicine | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2005-05-24 |
| 1184244493 | Kristy Michelle Keirsey | Dental Hygienist | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2020-04-16 |
| 1538788310 | Wendy Lynn Weston | Nurse Practitioner | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2020-04-13 |
| 1841842713 | Lyrra Suszanne Stucker | Registered Nurse | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2019-07-11 |
| 1043874803 | Deirdre Stocks | Nurse Practitioner | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2019-04-26 |
| 1053892026 | Janet Lee Turner | Pharmacist | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2018-08-27 |
| 1215450291 | Richard Ladka | Pharmacist | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2017-07-20 |
| 1285157388 | Jessica Lynn Libla | Nurse Practitioner | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2017-07-20 |
| 1780107995 | Hannah Irene Terry | Pharmacist | 1500 N Westwood Blvd, Poplar Bluff, MO 63901 | 2017-07-19 |
| 1780112953 | Lyntoria Rochelle Williams | Social Worker | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2017-05-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076701 | Alternative Sleep Solution | Dentist | 2700 Kanell Blvd., Poplar Bluff, MO 63901 | 2020-09-04 |
| 1285271239 | Front Door Wellness LLC | Physical Therapist | Front Door Wellness LLC, 5835 Quail Meadows Drive, Poplar Bluff, MO 63901 | 2019-12-09 |
| 1104470368 | Andrew Akindutire | Dentist | 3101 Oak Groove Rd., Suite 6, Poplar Bluff, MO 63901 | 2019-07-26 |
| 1780195966 | Midwest Equipment Srv Systems LLC | Technician, Pathology | 2400 Lucy Lee Parkway, Suite C, Poplar Bluff, MO 63901 | 2017-10-16 |
| 1801259387 | Richard Justin Huber | Technician, Other | 3005 Warrior Ln, Poplar Bluff, MO 63901 | 2016-04-01 |
| 1699136275 | Donja Kirkland | Recreation Therapist | 1910a Greenwood Dr., Suite D, Poplar Bluff, MO 63901 | 2016-03-10 |
| 1760866867 | Bio-medical Applications of Missouri, Inc. | Clinic/Center | 3050 Tucker Road, Poplar Bluff, MO 63901 | 2015-07-17 |
| 1407246390 | Lisa Marie Payne | Physical Therapist | 4358c Highway Pp, Poplar Bluff, MO 63901 | 2015-01-29 |
| 1700202488 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 1602 W. Harper Street, Poplar Bluff, MO 63901 | 2014-03-05 |
| 1932521648 | Essential Family Healthcare, LLC | Clinic/Center | 1369 North Westwood Blvd., Poplar Bluff, MO 63901 | 2014-01-15 |
| Find all providers in zip 63901 | ||||
| Taxonomy Code | 332100000X |
| Grouping | Suppliers |
| Classification | Department of Veterans Affairs (VA) Pharmacy |
| Department of Veterans Affairs (VA) Pharmacy means any place under VA jurisdiction where drugs are dispensed and Pharmaceutical Care is provided to enrolled Veterans, by licensed pharmacists. The Pharmacy is reviewed by JCAHO, utilizes the VA hospital’s DEA number, and has a designated NCPDP number. VA facility pharmacies include Inpatient (Institutional), Outpatient, Consolidated Mail Outpatient Pharmacies (CMOPs), Research, Addiction Treatment Centers, Long Term Care and Community Based Outpatient Clinics Pharmacies. The VHA Pharmacy Benefits Management - Strategic Healthcare Group has oversight for professional and practice activities of VA Pharmacies. Each pharmacy is under the direct supervision of a U.S. or U.S. territory licensed pharmacist, and has staffing to meet its designated scope of service. |
| Notes: Source: Pharmacy Benefits Management – Strategic Healthcare Group, Veterans Health Administration, Department of Veterans Affairs [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366824351 | Walgreens Pharmacy | Department of Veterans Affairs (VA) Pharmacy | 12345 Saint Charles Rock Rd, Bridgeton, MO 63044-2505 | 2015-06-25 |
| 1659547800 | Fayetteville Vamc | Department of Veterans Affairs (VA) Pharmacy | 1850 W Republic Rd, Springfield, MO 65807-5730 | 2008-05-07 |
| 1912180357 | St. Louis Jc Vamc | Department of Veterans Affairs (VA) Pharmacy | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2007-12-07 |
| 1558319715 | St. Louis Jc Vamc | Department of Veterans Affairs (VA) Pharmacy | 1 Jefferson Barracks Dr, Saint Louis, MO 63125-4181 | 2006-05-04 |
| 1194783001 | Kansas City Vamc | Department of Veterans Affairs (VA) Pharmacy | 800 Hospital Dr, Columbia, MO 65201-5275 | 2006-05-02 |
| 1326006149 | Kansas City Vamc | Department of Veterans Affairs (VA) Pharmacy | 4801 E Linwood Blvd, Kansas City, MO 64128-2226 | 2006-05-02 |
| City | POPLAR BLUFF |
| Zip Code | 63901 |
Please comment or provide details below to improve the information on ST. LOUIS JC VAMC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.