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General NPI Number Information
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NPI Number | 1083172043
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Entity Type | Organization
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Legal Business Name | ST. JUDE LABORATORIES LLC
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 8950 ROUTE 108 STE 121
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City | COLUMBIA
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State | MD
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Zip | 21045-2150
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Country | US
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Telephone | 410-862-8162
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Fax | 410-630-7474
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Provider Business Mailing Address
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Address Line | 8950 ROUTE 108 STE 121
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City | COLUMBIA
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State | MD
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Zip | 21045-2150
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Country | US
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Telephone | 410-862-8162
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Fax | 410-630-7474
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOSE KALAMPANAYIL
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Credential |
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Telephone | 410-884-4120
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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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