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General NPI Number Information
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NPI Number | 1710676515
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Entity Type | Organization
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Legal Business Name | OPULENT LUX LAB
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 1018 E 35TH AVE APT OL
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City | GRIFFITH
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State | IN
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Zip | 46319-1218
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Country | US
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Telephone | 708-200-8675
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Fax |
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Provider Business Mailing Address
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Address Line | 1018 E 35TH AVE APT OL
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City | GRIFFITH
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State | IN
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Zip | 46319-1218
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Country | US
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Telephone | 708-200-8675
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. PAMELA JAMES
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Credential | CRMA PHLEBOTOMIST
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Telephone | 708-200-8675
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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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