Healthcare Provider Details

I. General information

NPI: 1396564654
Provider Name (Legal Business Name): AXIVARX OF MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 CLAYTON ROAD SUITE 220
LADUE MO
63124
US

IV. Provider business mailing address

9890 CLAYTON RD STE 220
SAINT LOUIS MO
63124-1685
US

V. Phone/Fax

Practice location:
  • Phone: 844-442-9482
  • Fax: 844-440-0101
Mailing address:
  • Phone: 844-442-9482
  • Fax: 844-440-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN S SHAPIRO
Title or Position: MANAGING MEMBER/PRESIDENT
Credential:
Phone: 844-442-9482