Provider Demographics
NPI:1609229921
Name:OPTIME CARE INC
Entity Type:Organization
Organization Name:OPTIME CARE INC
Other - Org Name:OPTIME CARE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-597-4221
Mailing Address - Street 1:4060 WEDGEWAY CT
Mailing Address - Street 2:
Mailing Address - City:EARTH CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63045-1213
Mailing Address - Country:US
Mailing Address - Phone:314-731-6900
Mailing Address - Fax:314-731-6901
Practice Address - Street 1:4060 WEDGEWAY CT
Practice Address - Street 2:
Practice Address - City:EARTH CITY
Practice Address - State:MO
Practice Address - Zip Code:63045-1213
Practice Address - Country:US
Practice Address - Phone:314-731-6900
Practice Address - Fax:314-731-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20160113083336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163714OtherPK
MO1609229921Medicaid