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General NPI Number Information
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NPI Number | 1184039950
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Entity Type | Organization
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Legal Business Name | NEUTRON LAB LLC
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 440 STATE HIGHWAY 78 STE 230
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City | LAVON
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State | TX
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Zip | 75166-1266
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Country | US
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Telephone | 972-843-7010
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Fax | 972-200-3017
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Provider Business Mailing Address
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Address Line | 440 STATE HIGHWAY 78 STE 230
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City | LAVON
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State | TX
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Zip | 75166-1266
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Country | US
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Telephone | 972-843-7010
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Fax | 972-200-3017
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Authorized Official
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Title or Position | MANAGING OFFICER
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Name | MARIAMME FERREIRO
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Credential | PHARM D
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Telephone | 972-843-7010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 29073
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License Number State | TX
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