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General NPI Number Information
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NPI Number | 1073385233
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Entity Type | Organization
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Legal Business Name | WATER GLASS LABORATORIES TAMPA BAY LLC
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 5880 49TH ST N STE 205
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City | ST PETERSBURG
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State | FL
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Zip | 33709-2147
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Country | US
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Telephone | 727-677-1018
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Fax |
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Provider Business Mailing Address
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Address Line | 5880 49TH ST N STE 205
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City | ST PETERSBURG
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State | FL
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Zip | 33709-2147
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Country | US
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Telephone | 727-677-1018
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER MARIE RIVARD
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Credential |
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Telephone | 727-677-1018
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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 |
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License Number State |
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