Provider Demographics
NPI:1649093931
Name:MOLECULAB LLC
Entity type:Organization
Organization Name:MOLECULAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:V
Authorized Official - Last Name:GUILBAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-296-7859
Mailing Address - Street 1:13027 HWY 155 S STE 400
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6560
Mailing Address - Country:US
Mailing Address - Phone:985-646-8014
Mailing Address - Fax:
Practice Address - Street 1:13027 HWY 155 S STE 400
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6560
Practice Address - Country:US
Practice Address - Phone:985-646-8014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory