Healthcare Provider Details

I. General information

NPI: 1912827957
Provider Name (Legal Business Name): IBC LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE 13950
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

15 SWEET GRACIE HOLW NW
CARTERSVILLE GA
30120-7734
US

V. Phone/Fax

Practice location:
  • Phone: 770-383-0468
  • Fax:
Mailing address:
  • Phone: 770-383-0468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALI BAHADUR
Title or Position: CEO
Credential:
Phone: 770-383-0468