Provider Demographics
NPI:1356527709
Name:TRANS ALLIANCE LAB
Entity type:Organization
Organization Name:TRANS ALLIANCE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHINWE
Authorized Official - Middle Name:BIBI
Authorized Official - Last Name:NWABUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-992-9940
Mailing Address - Street 1:1875 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 815
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2201
Mailing Address - Country:US
Mailing Address - Phone:770-992-9940
Mailing Address - Fax:
Practice Address - Street 1:1875 OLD ALABAMA RD
Practice Address - Street 2:SUITE 815
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2201
Practice Address - Country:US
Practice Address - Phone:770-992-9940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5235820001Medicare NSC