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General NPI Number Information
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NPI Number | 1780457002
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Entity Type | Organization
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Legal Business Name | MY CHEM LAB LLC
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 602 JACKSON ST
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City | WILDWOOD
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State | FL
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Zip | 34785-3301
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Country | US
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Telephone | 352-571-3148
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 572
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City | WILDWOOD
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State | FL
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Zip | 34785-0572
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Country | US
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Telephone | 352-571-3148
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TASHA D LASANE
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Credential |
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Telephone | 352-571-3148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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