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General NPI Number Information
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NPI Number | 1396144531
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Entity Type | Organization
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Legal Business Name | NORTH AMERICAN CUSTOM LABORATORIES LLC
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 1736 N GREENVILLE AVE
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City | RICHARDSON
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State | TX
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Zip | 75081-1808
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Country | US
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Telephone | 214-390-9990
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Fax | 214-432-8922
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Provider Business Mailing Address
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Address Line | 1736 N GREENVILLE AVE
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City | RICHARDSON
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State | TX
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Zip | 75081-1808
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Country | US
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Telephone | 214-390-9990
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Fax | 214-432-8922
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Authorized Official
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Title or Position | PRESIDENT/PIC
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Name | JUSTIN GRAVES
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Credential |
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Telephone | 214-240-6208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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