Provider Demographics
NPI:1497219778
Name:INOCULA, LLC
Entity Type:Organization
Organization Name:INOCULA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:E
Authorized Official - Last Name:DRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-797-7804
Mailing Address - Street 1:8008 MANX DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3864
Mailing Address - Country:US
Mailing Address - Phone:888-626-4240
Mailing Address - Fax:512-876-2227
Practice Address - Street 1:8008 MANX DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3864
Practice Address - Country:US
Practice Address - Phone:888-626-4240
Practice Address - Fax:512-876-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies