Provider Demographics
NPI:1043964257
Name:PUREPATH LAB & THERAPEUTICS, LLC
Entity type:Organization
Organization Name:PUREPATH LAB & THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEMRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-464-4522
Mailing Address - Street 1:570 S EDMONDS LN STE 104
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3542
Mailing Address - Country:US
Mailing Address - Phone:469-464-4522
Mailing Address - Fax:
Practice Address - Street 1:570 S EDMONDS LN STE 104
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3542
Practice Address - Country:US
Practice Address - Phone:714-249-0645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory