Organization
PROLAB
Active
Other names
PROLAB PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JAY TEAGUE (VP)
(903) 785-8750
Entity
Organization
Contact information
Practice address
3020 LAMAR AVE, PARIS, TX 75460-5014
(903) 785-8750
(903) 785-1357
Mailing address
PO BOX 6794, PARIS, TX 75461-6794
(903) 785-8750
(903) 785-1357
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
21363
TX
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2098808
PK
—
Enumeration date
06/11/2006
Last updated
11/09/2015
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