Provider Demographics
NPI:1538568803
Name:MED-LAB COMPOUNDING
Entity type:Organization
Organization Name:MED-LAB COMPOUNDING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NEREYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-534-7533
Mailing Address - Street 1:9963 SW 142 AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:786-534-7533
Mailing Address - Fax:
Practice Address - Street 1:9963 SW 142ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6844
Practice Address - Country:US
Practice Address - Phone:786-534-7533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH283303336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147240OtherPK