Provider Demographics
NPI:1689193732
Name:CHOICE FLU VACCINATIONS
Entity Type:Organization
Organization Name:CHOICE FLU VACCINATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-200-4071
Mailing Address - Street 1:8016 KNIGHTS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6208
Mailing Address - Country:US
Mailing Address - Phone:314-200-4071
Mailing Address - Fax:314-200-4059
Practice Address - Street 1:8016 KNIGHTS CROSSING DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6208
Practice Address - Country:US
Practice Address - Phone:314-200-4071
Practice Address - Fax:314-200-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service