Healthcare Provider Details

I. General information

NPI: 1447906771
Provider Name (Legal Business Name): SEFORA ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5819 S LINDBERGH BLVD
SAINT LOUIS MO
63123-6948
US

IV. Provider business mailing address

6 WATERFRONT GRV
SAINT CHARLES MO
63303-4816
US

V. Phone/Fax

Practice location:
  • Phone: 636-373-7966
  • Fax:
Mailing address:
  • Phone: 636-373-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNEETHA MARE
Title or Position: PRESIDENT
Credential:
Phone: 636-373-7966