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General NPI Number Information
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NPI Number | 1780075986
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Entity Type | Organization
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Legal Business Name | IBA MOLECULAR NORTH AMERICA, INC
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 4447 BRASS WAY
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City | DALLAS
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State | TX
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Zip | 75236-2001
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Country | US
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Telephone | 214-331-2268
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Fax | 214-331-2450
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Provider Business Mailing Address
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Address Line | 4447 BRASS WAY
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City | DALLAS
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State | TX
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Zip | 75236-2001
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Country | US
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Telephone | 214-331-2268
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Fax | 214-331-2450
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | JULIUS MARTIN III
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Credential | PHARMD
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Telephone | 214-331-2268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336N0007X
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Taxonomy Name | Nuclear Pharmacy
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License Number | PHY.006506-NR
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 3336N0007X
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Taxonomy Name | Nuclear Pharmacy
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License Number | 99-5936
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 3336N0007X
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Taxonomy Name | Nuclear Pharmacy
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License Number | 22-10390
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 3336N0007X
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Taxonomy Name | Nuclear Pharmacy
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License Number | 26246
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License Number State | TX
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