Healthcare Provider Details

I. General information

NPI: 1346009180
Provider Name (Legal Business Name): ST LUKE LAB , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9338 LITTLE RD
NEW PORT RICHEY FL
34654-3415
US

IV. Provider business mailing address

9338 LITTLE RD
NEW PORT RICHEY FL
34654-3415
US

V. Phone/Fax

Practice location:
  • Phone: 718-223-3464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHAKER
Title or Position: OWNER
Credential:
Phone: 718-223-3464