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General NPI Number Information
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NPI Number | 1285037945
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Entity Type | Organization
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Legal Business Name | INTERLAB LLC
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 2730 S SAINT PETERS PKWY SUITE 200
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City | SAINT PETERS
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State | MO
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Zip | 63303-5677
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Country | US
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Telephone | 636-486-0436
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Fax | 636-486-1894
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Provider Business Mailing Address
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Address Line | PO BOX 958514
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City | SAINT LOUIS
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State | MO
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Zip | 63195-8514
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Country | US
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Telephone | 636-486-0436
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Fax | 636-486-1894
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Authorized Official
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Title or Position | OWNER
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Name | MALIK KARIM
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Credential |
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Telephone | 314-960-1052
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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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