Provider Demographics
NPI:1093128522
Name:LABORATORYRX OF MARYLAND, LLC
Entity Type:Organization
Organization Name:LABORATORYRX OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-916-3070
Mailing Address - Street 1:60 W TERRA COTTA AVE STE B
Mailing Address - Street 2:STE 265
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3548
Mailing Address - Country:US
Mailing Address - Phone:410-916-3070
Mailing Address - Fax:
Practice Address - Street 1:9538 DEERECO RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2119
Practice Address - Country:US
Practice Address - Phone:410-916-3070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy