=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396361408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DERMADRY LABORATORIES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2020
-----------------------------------------------------
Last Update Date | 06/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9223 LANGELIER BOULEVARD
-----------------------------------------------------
City | ST-LEONARD
-----------------------------------------------------
State | QUEBEC
-----------------------------------------------------
Zip | H1P3K9
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone | 514-903-9897
-----------------------------------------------------
Fax | 514-400-6205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9223 LANGELIER BOULEVARD
-----------------------------------------------------
City | ST-LEONARD
-----------------------------------------------------
State | QUEBEC
-----------------------------------------------------
Zip | H1P3K9
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. NICOLAS JOLICOEUR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 514-903-9897
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------