Healthcare Provider Details

I. General information

NPI: 1487298881
Provider Name (Legal Business Name): FOUNDATION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CHESTERFIELD INDUSTRIAL BLVD STE 115
CHESTERFIELD MO
63005-1219
US

IV. Provider business mailing address

PO BOX 955362
SAINT LOUIS MO
63195-5362
US

V. Phone/Fax

Practice location:
  • Phone: 877-291-1122
  • Fax: 877-291-1155
Mailing address:
  • Phone: 855-422-2742
  • Fax: 866-834-8523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSICA DAWN CICCOLELLA-KAHL
Title or Position: PRESIDENT, DIRECTOR
Credential:
Phone: 800-511-5144