Provider Demographics
NPI:1902228265
Name:KOMLACARE
Entity Type:Organization
Organization Name:KOMLACARE
Other - Org Name:KOMLA CONSULTING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYIBOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:314-303-8225
Mailing Address - Street 1:1639 SPRING CHASE DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-6964
Mailing Address - Country:US
Mailing Address - Phone:314-303-8225
Mailing Address - Fax:
Practice Address - Street 1:1639 SPRING CHASE DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-6964
Practice Address - Country:US
Practice Address - Phone:314-303-8225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service