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General NPI Number Information
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NPI Number | 1649636275
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Entity Type | Organization
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Legal Business Name | GENETICARE LABORATORY INC.
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 2901 UNION RD SUITE 250
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City | SAINT LOUIS
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State | MO
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Zip | 63125-3972
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Country | US
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Telephone | 314-200-3109
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Fax | 314-200-3107
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Provider Business Mailing Address
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Address Line | 2901 UNION RD SUITE 250
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City | SAINT LOUIS
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State | MO
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Zip | 63125-3972
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Country | US
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Telephone | 314-200-3109
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Fax | 314-200-3107
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DEBBIE LYNN CAMILLO
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Credential |
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Telephone | 618-344-2920
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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 | 26D2014386
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License Number State | MO
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