Provider Demographics
NPI:1174775647
Name:TRANS ALLIANCE LAB INC
Entity type:Organization
Organization Name:TRANS ALLIANCE LAB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHINWE
Authorized Official - Middle Name:B
Authorized Official - Last Name:NWABUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-699-9000
Mailing Address - Street 1:PO BOX 767757
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-7757
Mailing Address - Country:US
Mailing Address - Phone:404-699-9000
Mailing Address - Fax:
Practice Address - Street 1:3050 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1500
Practice Address - Country:US
Practice Address - Phone:404-699-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANS ALLIANCE MED AND DRUGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5784610001Medicare NSC