Provider Demographics
NPI:1720503824
Name:MEDLAB PHARMACY INC
Entity Type:Organization
Organization Name:MEDLAB PHARMACY INC
Other - Org Name:MEDLAB PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:954-400-0560
Mailing Address - Street 1:7300 W MCNAB RD STE 112
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5329
Mailing Address - Country:US
Mailing Address - Phone:954-400-0560
Mailing Address - Fax:954-606-5260
Practice Address - Street 1:7300 W MCNAB RD STE 112
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5329
Practice Address - Country:US
Practice Address - Phone:954-400-0560
Practice Address - Fax:950-606-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
FLPH308933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170922OtherPK