01D2273583 CLIA NUMBER - MOULTRIE PHARMACY AT CADDO

Laboratory Demographics

  • CLIA Code: 01D2273583
  • Facility Name: MOULTRIE PHARMACY AT CADDO
  • Facility Address: 22747 AL HIGHWAY 24 SUITE D
    MOULTON, AL
    ZIP 35650
  • Facility Phone: 256 905-0030
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. BENJAMIN D. MOULTRIE
  • NPI Number: 1841941093
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2273583
LAB Type Pharmacy
Facility Name MOULTRIE PHARMACY AT CADDO
Street 22747 AL HIGHWAY 24 SUITE D
City MOULTON
State AL
ZIP 35650
Phone 256 905-0030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Pharmacy
Lab Director MR. BENJAMIN D. MOULTRIE

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This page was last updated on: 9/29/2025