ST. LOUIS JC VAMC (NPI# 1912180357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912180357 |
| Entity Type | Organization |
| Organization Name | ST. LOUIS JC VAMC |
| Other Organization Name | ST. LOUIS JC VAMC PHARMACY |
| Practice Address |
915 N Grand Blvd Saint Louis MO 63106-1621 |
| Mailing Address |
Po Box 94462 Cleveland OH 44101-4462 |
| Practice Telephone | 3148946501 |
| Practice Fax Number | 3148945731 |
| Mailing Telephone | 9135784409 |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2019-07-09 |
| 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 | 2636009 | 01 |
| Other Name | Type Code |
|---|---|
| ST. LOUIS JC 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 |
915 N GRAND BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63106-1621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033115480 | Jamie Lynn Swanson | Physician Assistant | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2005-06-21 |
| 1821602756 | Courtney Kay Duberry | Optometrist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-09-08 |
| 1043820053 | Kathryn Marie Storm | Pharmacist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-08-04 |
| 1326657230 | Rebecca Oluwafunmito Babalola | Pharmacist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-27 |
| 1639787328 | Justin Clarke Liedke | Pharmacist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-19 |
| 1639796899 | Taylor Anderson | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-02 |
| 1427675800 | Lauren Elizabeth Smith | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-01 |
| 1427675925 | Christa Marie Stoutenborough | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-06-30 |
| 1992322739 | Alexia Lambos Georges | Perfusionist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-06-27 |
| 1912522210 | Meaghan Elizabeth Lecture | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-06-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770027997 | Superior Manor of Downtown LLC | Assisted Living Facility | 1501 Clinton St., St Louis, MO 63106 | 2016-12-07 |
| 1811361454 | James Preston Jr. | Pharmacist | 915 N. Grand Vlvd, Pharmacy Dept., John Cochran Va Medical Center, Saint Louis, MO 63106 | 2015-11-19 |
| 1245656354 | Julie Marie Albsmeyer | Physician Assistant | 915 North Grand 111-jc-gi, John Cochran Va Hospital, St. Louis, MO 63106 | 2014-03-13 |
| 1932523230 | Cathy Yeung | Registered Nurse | 715 N Grand Blvd., St Louis, MO 63106 | 2014-02-07 |
| 1902149388 | Amanda Foley | Doula | 4056 Humphrey Street, Saint Louis, MO 63106 | 2013-04-03 |
| 1942569876 | Cornelia Charles | Internal Medicine | 915 Norh Grand Blvd, Saint Louis, MO 63106 | 2012-05-12 |
| 1124334396 | Kasandra Ann Tinajero | Registered Nurse | 915 N. Grand Blvd., St. Louis, MO 63106 | 2010-08-26 |
| 1366673931 | Cassandra Vernetta Talbert | Social Worker | 915 N. Grand., 122/jc Social Work Dept. V.a. Medical Center, St. Louis, MO 63106 | 2009-07-30 |
| 1497910707 | Robert Louis Tillman | Pharmacy Technician | 915 N Grand Ave, St. Louis, MO 63106 | 2008-07-25 |
| 1861676686 | Bradley Dean Overmeyer | Social Worker | 915 N Grand Blvd., Social Work Service, St. Louis, MO 63106 | 2007-12-28 |
| Find all providers in zip 63106 | ||||
| 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 |
|---|---|---|---|---|
| 1558319715 | St. Louis Jc Vamc | Department of Veterans Affairs (VA) Pharmacy | 1 Jefferson Barracks Dr, Saint Louis, MO 63125-4181 | 2006-05-04 |
| 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 |
| 1588622880 | St. Louis Jc Vamc | Department of Veterans Affairs (VA) Pharmacy | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2006-05-03 |
| 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 | SAINT LOUIS |
| Zip Code | 63106 |
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| 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.