MEDICARE: ALLORA LABORATORY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1891312179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLORA LABORATORY, LLC

Provider Business Mailing Address
First Line	:	405 SAINT JOHNS CHURCH RD STE 104
Second Line	:
City	:	CAMP HILL
State	:	PA
Zip	:	17011-5739
Country	:	US
Telephone Number	:	717-216-8131
Fax Number	:	717-850-8039

Provider Business Practice Location Address
First Line	:	405 SAINT JOHNS CHURCH RD STE 104
Second Line	:
City	:	CAMP HILL
State	:	PA
Zip	:	17011-5739
Country	:	US
Telephone Number	:	717-216-8131
Fax Number	:	717-850-8039

Authorized Official
Title or Position	:	COO
Name	:	SARAH JOHNSTON
Credential	:	MS, MLS (ASCP)
Telephone Number	:	717-491-5371

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	07/02/2020

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