Provider Demographics
NPI:1780457002
Name:MY CHEM LAB LLC
Entity type:Organization
Organization Name:MY CHEM LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LASANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-571-3148
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-0572
Mailing Address - Country:US
Mailing Address - Phone:352-571-3148
Mailing Address - Fax:
Practice Address - Street 1:602 JACKSON ST
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-3301
Practice Address - Country:US
Practice Address - Phone:352-571-3148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty