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General NPI Number Information
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NPI Number | 1043736911
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Entity Type | Organization
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Legal Business Name | 1ST. STICK MEDICAL DRAW STATION
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 1405 WESTOVER HILLS BLVD STE 1A
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City | RICHMOND
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State | VA
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Zip | 23225-3153
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Country | US
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Telephone | 804-424-3260
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Fax | 804-424-3261
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Provider Business Mailing Address
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Address Line | 4331 BATHGATE RD
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City | RICHMOND
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State | VA
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Zip | 23234-3581
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Country | US
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Telephone | 804-549-9115
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TELLY LESHAN OWENS
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Credential |
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Telephone | 804-424-3260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 246RP1900X
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License Number State | VA
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