Healthcare Provider Details

I. General information

NPI: 1770055972
Provider Name (Legal Business Name): VALKRIE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 ENTERPRISE AVE
MYRTLE BEACH SC
29577-6546
US

IV. Provider business mailing address

1430 ENTERPRISE AVE
MYRTLE BEACH SC
29577-6546
US

V. Phone/Fax

Practice location:
  • Phone: 843-997-2873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PRINY NEWBY
Title or Position: OWNER
Credential:
Phone: 843-997-2873