Provider Demographics
NPI:1396564654
Name:AXIVARX OF MISSOURI LLC
Entity type:Organization
Organization Name:AXIVARX OF MISSOURI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:STACY
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-955-0920
Mailing Address - Street 1:9890 CLAYTON ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LADUE
Mailing Address - State:MO
Mailing Address - Zip Code:63124
Mailing Address - Country:US
Mailing Address - Phone:844-442-9482
Mailing Address - Fax:844-440-0101
Practice Address - Street 1:9890 CLAYTON ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:LADUE
Practice Address - State:MO
Practice Address - Zip Code:63124
Practice Address - Country:US
Practice Address - Phone:844-442-9482
Practice Address - Fax:844-440-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy