Organization
PAMELA ADENUGA
Active
Parent organization
HIS GRACE MEDICAL SUPPLY AND MORE
Other names
His Grace Lab Company
Organization subpart
Yes
Provider details
NPI number
Legal business name
HIS GRACE MEDICAL SUPPLY AND MORE
Authorized official
PAMELA ADENUGA (DIRECTOR)
(817) 704-8081
Entity
Organization
Contact information
Practice address
1901 SOUTHEAST PKWY, SUITE 106, ARLINGTON, TX 76018-3605
(817) 704-8081
Mailing address
1901 SOUTHEAST PKWY, SUITE 106, ARLINGTON, TX 76018-3605
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D1091543
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D1091543
CLIA
TX
Enumeration date
01/08/2010
Last updated
03/02/2010
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