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General NPI Number Information
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NPI Number | 1437778487
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Entity Type | Organization
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Legal Business Name | SPECIAL FRIEND LABORATORY LLC
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 9212 S COMMERCIAL AVE
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City | CHICAGO
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State | IL
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Zip | 60617-4508
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Country | US
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Telephone | 773-359-3373
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Fax | 773-634-8070
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Provider Business Mailing Address
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Address Line | 9212 S COMMERCIAL AVE
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City | CHICAGO
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State | IL
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Zip | 60617-4508
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Country | US
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Telephone | 773-359-3373
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Fax | 773-634-8070
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Authorized Official
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Title or Position | MANAGER
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Name | MS. CAROL A REED
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Credential | PHLEBOTOMIST
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Telephone | 773-359-3373
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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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