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General NPI Number Information
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NPI Number | 1144010794
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Entity Type | Organization
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Legal Business Name | DRAVEXIUM LLC
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 3910 S OLD HIGHWAY 94 STE 102
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City | SAINT CHARLES
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State | MO
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Zip | 63304-2834
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Country | US
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Telephone | 502-907-8553
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Fax |
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Provider Business Mailing Address
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Address Line | 201 US HIGHWAY 60 W STE 217
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City | REPUBLIC
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State | MO
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Zip | 65738-1432
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARAN MUNAGALA
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Credential |
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Telephone | 502-907-8553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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