Healthcare Provider Details

I. General information

NPI: 1639609209
Provider Name (Legal Business Name): LICE BUSTERS ST. LOUIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7923 BIG BEND BLVD
SAINT LOUIS MO
63119-2703
US

IV. Provider business mailing address

7923 BIG BEND BLVD
SAINT LOUIS MO
63119-2703
US

V. Phone/Fax

Practice location:
  • Phone: 314-329-5423
  • Fax:
Mailing address:
  • Phone: 314-329-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH LUTZ
Title or Position: OWNER
Credential:
Phone: 314-973-9837