# COVENANT LAB SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053067215
- **Authorized official:** MRS. ALICIA TUCKER (OWNER)
- **Authorized official phone:** (813) 851-3140

## Contact information

- **Practice address:** 110 LITHIA PINECREST RD STE H, OFFICE D, BRANDON, FL 33511-5300
- **Practice address phone:** (813) 851-3140
- **Practice address fax:** (813) 851-3141
- **Mailing address:** 401 E JACKSON ST STE 2340, TAMPA, FL 33602-5226
- **Mailing address phone:** (813) 851-3140
- **Mailing address fax:** (813) 851-3141

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 247ZC0005X | Clinical Laboratory Director (Non-physician) | — | NULL | Yes |
| 247ZC0005X | Clinical Laboratory Director (Non-physician) | — | — | Yes |

## Other

- **Enumeration date:** 02/25/2022
- **Last updated:** 02/25/2022