Organization
MIXLAB WI, LLC
Active
Parent organization
MIXLAB, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIXLAB, INC.
Authorized official
VINNIE DAM PHARMD, MS (CHIEF PHARMACY OFFICER)
(347) 610-9820
Entity
Organization
Contact information
Practice address
407 W SILVER SPRING DR, MILWAUKEE, WI 53217-5048
(888) 901-4480
(212) 967-0892
Mailing address
407 W SILVER SPRING DR, MILWAUKEE, WI 53217-5048
(888) 901-4480
(212) 967-0892
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Enumeration date
11/26/2024
Last updated
11/26/2024
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