Provider Demographics
NPI:1801126214
Name:LAB DRUGS & MEDICAL -TRANS-SUPPLIES LLC
Entity type:Organization
Organization Name:LAB DRUGS & MEDICAL -TRANS-SUPPLIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-777-5995
Mailing Address - Street 1:8561 EDINBURGH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3724
Mailing Address - Country:US
Mailing Address - Phone:763-777-5995
Mailing Address - Fax:763-777-5974
Practice Address - Street 1:8561 EDINBURGH CENTER DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3724
Practice Address - Country:US
Practice Address - Phone:763-777-5995
Practice Address - Fax:763-777-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN263458332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1801126214Medicaid
730000092OtherMASS IMMUIZATION PTAN
2429959OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MN263458OtherPHARMACY LICENSE
6683140001Medicare NSC