NPIMap

Organization Active NPI

Mixlab, Inc.

  • Pharmacy
  • New York, NY
National Provider Identifier
1407365679
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
035768 Issued in NY
Legal business name
MIXLAB, INC.
Practice address
336 W 37TH St RM 850
New York, NY 10018-4280
Phone
(888) 901-4480
NPI assigned
Sep 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vinnie Dam, PHARMD, MS
Title
Chief Pharmacy Officer
Phone
(347) 610-9820

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 035768 NY Primary
Community/Retail Pharmacy 3336C0003X 035768 NY
Compounding Pharmacy 3336C0004X 035768 NY

Addresses

Primary practice location

336 W 37TH St RM 850
New York, NY 10018-4280

Mailing address

336 W 37TH St RM 850
New York, NY 10018-4280
Phone (888) 901-4480

National Provider Directory

National Provider Directory
Tax ID family
Mixlab Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

336 W 37th St
Rm 850
New York, NY 10018
Phone (888) 901-4480

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601856000000",
    "number": "1407365679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 W 37TH ST RM 850",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100184280",
            "telephone_number": "888-901-4480",
            "fax_number": "212-967-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 W 37TH ST RM 850",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100184280",
            "telephone_number": "888-901-4480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIXLAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-20",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A",
        "authorized_official_last_name": "DAM",
        "authorized_official_first_name": "VINNIE",
        "authorized_official_title_or_position": "CHIEF PHARMACY OFFICER",
        "authorized_official_telephone_number": "347-610-9820",
        "authorized_official_credential": "PHARMD, MS"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "035768",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "035768",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NY",
            "license": "035768",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.