01D0995199 CLIA NUMBER - MONTGOMERY JOB CORPS WELLNESS CENTER

Laboratory Demographics

CLIA Number: 01D0995199

Facility Name: MONTGOMERY JOB CORPS WELLNESS CENTER

Facility Address:
1145 AIR BASE BLVD
MONTGOMERY, AL
ZIP 36108
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Facility Phone Number: 334 420-2413

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1396785143

Taxonomy: 3336S0011X - Pharmacy
A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration.

CLIA Record

Field Name	Field Value
CLIA Number	01D0995199
LAB Type	School/Student Health Service
Facility Name	MONTGOMERY JOB CORPS WELLNESS CENTER
Street	1145 AIR BASE BLVD
City	MONTGOMERY
State	AL
ZIP	36108
Phone	334 420-2413
CertificateType	4
CertificateEffectiveDate	9/13/2022
CertificateExpirationDate	9/12/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024