Healthcare Provider Details

I. General information

NPI: 1619606183
Provider Name (Legal Business Name): PHLEX LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43996 WOODWARD AVE
BLOOMFIELD TOWNSHIP MI
48302-5027
US

IV. Provider business mailing address

43996 WOODWARD AVE
BLOOMFIELD TOWNSHIP MI
48302-5027
US

V. Phone/Fax

Practice location:
  • Phone: 947-208-0430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TYLA STOVALL-DANIEL
Title or Position: MANAGER
Credential:
Phone: 866-745-3931