=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831735992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WP PHARMA LABS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2019
-----------------------------------------------------
Last Update Date | 11/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4001 MCEWEN RD STE 110
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-5388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-722-4500
-----------------------------------------------------
Fax | 469-722-5500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4001 MCEWEN RD STE 110
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-5388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-722-4500
-----------------------------------------------------
Fax | 469-722-5500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JASON MCLAREN
-----------------------------------------------------
Credential | RPH, JD
-----------------------------------------------------
Telephone | 617-435-7375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------