Healthcare Provider Details

I. General information

NPI: 1548344864
Provider Name (Legal Business Name): ST LOUIS CONNECTCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 DELMAR BLVD
SAINT LOUIS MO
63112-3005
US

IV. Provider business mailing address

5535 DELMAR BLVD
SAINT LOUIS MO
63112-3005
US

V. Phone/Fax

Practice location:
  • Phone: 314-879-6208
  • Fax: 314-879-6323
Mailing address:
  • Phone: 314-879-6208
  • Fax: 314-879-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number2005036004
License Number StateMO

VIII. Authorized Official

Name: BRUCE J MEADOWS
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 314-879-6389