Organization
MIXLAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINNIE DAM PHARMD, MS (CHIEF PHARMACY OFFICER)
(347) 610-9820
Entity
Organization
Contact information
Practice address
336 W 37TH ST RM 850, NEW YORK, NY 10018-4280
(888) 901-4480
Mailing address
336 W 37TH ST RM 850, NEW YORK, NY 10018-4280
(888) 901-4480
(212) 967-0892
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
035768
NY
3336C0003X
Community/Retail Pharmacy
035768
NY
3336C0004X
Compounding Pharmacy
035768
NY
Other
Enumeration date
09/20/2017
Last updated
10/05/2020
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