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General NPI Number Information
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NPI Number | 1558947754
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Entity Type | Organization
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Legal Business Name | ARCH CITY LAB LLC
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Dates
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Enumeration Date | 03/19/2021
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 1515 N WARSON RD STE 101
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1108
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Country | US
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Telephone | 855-827-4777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | COTTLEVILLE
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State | MO
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Zip | 63338-0037
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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 | OWNER
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Name | NIKKO FARMER
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Credential |
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Telephone | 855-827-4777
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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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