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General NPI Number Information
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NPI Number | 1508720590
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Entity Type | Organization
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Legal Business Name | PURETEST DIAGNOSTICS
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Dates
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Enumeration Date | 12/13/2025
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 4966 PINEVIEW RIDGE RD
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City | MILTON
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State | FL
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Zip | 32571-8030
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Country | US
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Telephone | 850-426-8048
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Fax |
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Provider Business Mailing Address
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Address Line | 4966 PINEVIEW RIDGE RD
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City | MILTON
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State | FL
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Zip | 32571-8030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SHAQUILLE JOHNSON
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Credential |
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Telephone | 850-378-6225
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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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