Provider Demographics
NPI:1376209858
Name:KRA LAB SERVICES
Entity Type:Organization
Organization Name:KRA LAB SERVICES
Other - Org Name:KRA LAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAKIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:267-582-8843
Mailing Address - Street 1:6744 GUYER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-2611
Mailing Address - Country:US
Mailing Address - Phone:267-582-8843
Mailing Address - Fax:
Practice Address - Street 1:6744 GUYER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2611
Practice Address - Country:US
Practice Address - Phone:215-770-5404
Practice Address - Fax:215-770-5405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRA MOVES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-09
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center