Provider Demographics
NPI:1023551371
Name:RX LABS
Entity type:Organization
Organization Name:RX LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-832-4674
Mailing Address - Street 1:9005 TWO NOTCH RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5850
Mailing Address - Country:US
Mailing Address - Phone:803-832-4674
Mailing Address - Fax:803-753-8465
Practice Address - Street 1:109 HUNTERS RUN DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-9206
Practice Address - Country:US
Practice Address - Phone:803-832-4674
Practice Address - Fax:803-753-8465
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STARLEEN WALLER DBA RX LABS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
SC347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No291U00000XLaboratoriesClinical Medical Laboratory