OrganizationActiveAccepts Medicare
Ssm Health Care St. Louis
NPI 1639928690 · Community/Retail Pharmacy · O Fallon, MO
Enrolled with Medicare as Dme Supplier - Pharmacy · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1639928690
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Parent organization
- Ssm Health Care St. Louis
- Organization subpart
- Yes
- Authorized official
- Jeremy Fotheringham, Regional President(314) 994-7930
Specialties & taxonomies
Suppliers
Profile Score
Established profile(56/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
2 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
301 Caledonia Pkwy Ste 110
O Fallon, MO 63368-6690
Phone: (636) 202-6810
Fax: (636) 202-6811
Approximate (ZIP-level) locationGet directions
Mailing address
301 Caledonia Pkwy Ste 110
O Fallon, MO 63368-6690
Other names (DBA / former)
- Doing business as
- Ssm Health Prescription Center
- Doing business as
- Ssm Health Prescription Center
Registry dates
- Enumerated
- 2024-05-14
- Last updated
- 2025-05-19
- Certified
- 2025-05-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.