1396361408 NPI number — DERMADRY LABORATORIES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396361408 NPI number — DERMADRY LABORATORIES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMADRY LABORATORIES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396361408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9223 LANGELIER BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST-LEONARD
Provider Business Mailing Address State Name:
QUEBEC
Provider Business Mailing Address Postal Code:
H1P3K9
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9223 LANGELIER BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST-LEONARD
Provider Business Practice Location Address State Name:
QUEBEC
Provider Business Practice Location Address Postal Code:
H1P3K9
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
514-903-9897
Provider Business Practice Location Address Fax Number:
514-400-6205
Provider Enumeration Date:
06/24/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOLICOEUR
Authorized Official First Name:
NICOLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
514-903-9897

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)