Organization
CARESTL HEALTH #1
Active
Other names
MYRTLE HILLIARD DAVIS COMPREHENSIVE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA RENEE CLABON (CHIEF EXECUTIVE OFFICER)
(314) 367-5820
Entity
Organization
Contact information
Practice address
5471 DR MARTIN LUTHER KING DR, SAINT LOUIS, MO 63112-4265
(314) 367-5820
(314) 454-3979
Mailing address
5471 DR MARTIN LUTHER KING DR, SAINT LOUIS, MO 63112-4265
(314) 367-5820
(314) 367-6326
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
002938
MO
3336M0002X
Mail Order Pharmacy
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2050332
PK
—
05
—
600622914
—
MO
Enumeration date
01/11/2007
Last updated
03/31/2022
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