# MIXLAB, INC.

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

## Provider details

- **NPI number:** 1407365679
- **Authorized official:** VINNIE DAM PHARMD, MS (CHIEF PHARMACY OFFICER)
- **Authorized official phone:** (347) 610-9820

## Contact information

- **Practice address:** 336 W 37TH ST RM 850, NEW YORK, NY 10018-4280
- **Practice address phone:** (888) 901-4480
- **Mailing address:** 336 W 37TH ST RM 850, NEW YORK, NY 10018-4280
- **Mailing address phone:** (888) 901-4480
- **Mailing address fax:** (212) 967-0892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 035768 | NY | Yes |
| 3336C0003X | Community/Retail Pharmacy | 035768 | NY | — |
| 3336C0004X | Compounding Pharmacy | 035768 | NY | — |

## Other

- **Enumeration date:** 09/20/2017
- **Last updated:** 10/05/2020