Provider Demographics
NPI:1255478368
Name:MJ COLLECTIONS
Entity Type:Organization
Organization Name:MJ COLLECTIONS
Other - Org Name:MJ DRUG DNA TESTING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PUPILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CPCT
Authorized Official - Phone:219-713-4630
Mailing Address - Street 1:1418 E 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRIVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46310
Mailing Address - Country:US
Mailing Address - Phone:219-713-4630
Mailing Address - Fax:
Practice Address - Street 1:8924 WHITE OAK AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-713-4630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory