Healthcare Provider Details

I. General information

NPI: 1740194315
Provider Name (Legal Business Name): STORGE LABS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NW 12TH ST
POMPANO BEACH FL
33060-6097
US

IV. Provider business mailing address

101 NW 12TH ST
POMPANO BEACH FL
33060-6097
US

V. Phone/Fax

Practice location:
  • Phone: 405-404-6347
  • Fax:
Mailing address:
  • Phone: 405-404-6347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERRY GRAY
Title or Position: OWNER
Credential:
Phone: 405-830-6568