Healthcare Provider Details

I. General information

NPI: 1568097954
Provider Name (Legal Business Name): AVALCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 CLAYTON RD
SAINT LOUIS MO
63131
US

IV. Provider business mailing address

10431 CLAYTON RD
SAINT LOUIS MO
63131
US

V. Phone/Fax

Practice location:
  • Phone: 314-254-2311
  • Fax: 314-733-9091
Mailing address:
  • Phone: 314-254-2311
  • Fax: 314-733-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ABDUL RAHMAN ALMOUSALLI
Title or Position: OWNER
Credential:
Phone: 314-624-5941