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General NPI Number Information
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NPI Number | 1619606183
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Entity Type | Organization
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Legal Business Name | PHLEX LABS LLC
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 43996 WOODWARD AVE
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City | BLOOMFIELD TOWNSHIP
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State | MI
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Zip | 48302-5027
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Country | US
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Telephone | 947-208-0430
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Fax |
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Provider Business Mailing Address
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Address Line | 43996 WOODWARD AVE
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City | BLOOMFIELD TOWNSHIP
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State | MI
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Zip | 48302-5027
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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 | TYLA STOVALL-DANIEL
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Credential |
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Telephone | 866-745-3931
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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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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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