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General NPI Number Information
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NPI Number | 1578342150
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Entity Type | Organization
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Legal Business Name | MY LAB LLC
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 1108 E MAIN ST STE 906
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City | RICHMOND
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State | VA
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Zip | 23219-3534
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Country | US
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Telephone | 256-417-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 6803 CASTLETON DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-2582
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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 | OWNER & OPERATOR
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Name | PATHELIA RICE
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Credential | CCMA
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Telephone | 256-417-0303
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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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