Healthcare Provider Details

I. General information

NPI: 1699917518
Provider Name (Legal Business Name): TRANS ALLIANCE LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HEADLAND DR
EAST POINT GA
30344-2135
US

IV. Provider business mailing address

PO BOX 767757
ROSWELL GA
30076-7757
US

V. Phone/Fax

Practice location:
  • Phone: 404-530-0000
  • Fax: 404-530-0055
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE009574
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHINWE NWABUDE
Title or Position: PHARMACIST
Credential:
Phone: 404-699-9000