Provider Demographics
NPI:1295987931
Name:CLAREST HEALTH 7931, LLC
Entity type:Organization
Organization Name:CLAREST HEALTH 7931, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COMPLIANCE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BINCY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:631-359-9711
Mailing Address - Street 1:230 SEA LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3900
Mailing Address - Country:US
Mailing Address - Phone:631-359-9711
Mailing Address - Fax:631-212-5311
Practice Address - Street 1:509 S UNION AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2659
Practice Address - Country:US
Practice Address - Phone:417-865-2900
Practice Address - Fax:417-865-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X, 332B00000X, 3336C0003X
MO20080304213336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117411OtherPK
MO606395903Medicaid
2117411OtherPK