Provider Demographics
NPI:1780075986
Name:IBA MOLECULAR NORTH AMERICA, INC
Entity type:Organization
Organization Name:IBA MOLECULAR NORTH AMERICA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:214-331-2268
Mailing Address - Street 1:4447 BRASS WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75236-2001
Mailing Address - Country:US
Mailing Address - Phone:214-331-2268
Mailing Address - Fax:214-331-2450
Practice Address - Street 1:4447 BRASS WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75236-2001
Practice Address - Country:US
Practice Address - Phone:214-331-2268
Practice Address - Fax:214-331-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.006506-NR3336N0007X
OK99-59363336N0007X
KS22-103903336N0007X
TX262463336N0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336N0007XSuppliersPharmacyNuclear Pharmacy