Provider Demographics
NPI:1619373206
Name:ROCKY TOXICOLOGY LLC
Entity Type:Organization
Organization Name:ROCKY TOXICOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF LAB OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-377-9845
Mailing Address - Street 1:10 BURNETT CT STE 324
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-3611
Mailing Address - Country:US
Mailing Address - Phone:214-377-9845
Mailing Address - Fax:
Practice Address - Street 1:10 BURNETT CT STE 324
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-3611
Practice Address - Country:US
Practice Address - Phone:214-377-9845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory