Provider Demographics
NPI:1568097954
Name:AVALCARE INC
Entity Type:Organization
Organization Name:AVALCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALHALABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-973-3879
Mailing Address - Street 1:10431 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-254-2311
Mailing Address - Fax:314-733-9091
Practice Address - Street 1:10431 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-254-2311
Practice Address - Fax:314-733-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600054342Medicaid