MEDICARE: CARESTL HEALTH #3

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336M0002X	Mail Order Pharmacy
4	335E00000X	Prosthetic/Orthotic Supplier
5	3336C0002X	Clinic Pharmacy	2005035951	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2636299	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1740206697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESTL HEALTH #3

Provider Business Mailing Address
First Line	:	2425 WHITTIER ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-2950
Country	:	US
Telephone Number	:	314-371-3100
Fax Number	:	314-535-4662

Provider Business Practice Location Address
First Line	:	2425 WHITTIER ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-2950
Country	:	US
Telephone Number	:	314-371-3100
Fax Number	:	314-535-4662

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ANGELA RENEE CLABON
Credential	:
Telephone Number	:	314-367-5820

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	09/14/2020

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Directions to “CARESTL HEALTH #3 ” Practice Location

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