MEDICARE: INOCULA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1497219778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INOCULA, LLC

Provider Business Mailing Address
First Line	:	8008 MANX DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-3864
Country	:	US
Telephone Number	:	888-626-4240
Fax Number	:	512-876-2227

Provider Business Practice Location Address
First Line	:	8008 MANX DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-3864
Country	:	US
Telephone Number	:	888-626-4240
Fax Number	:	512-876-2227

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROGER E DRYE
Credential	:
Telephone Number	:	512-797-7804

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	01/30/2019

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