03D2211864 CLIA NUMBER - ALCHEMY APOTHECARY

Laboratory Demographics

CLIA Number: 03D2211864

Facility Name: ALCHEMY APOTHECARY

Facility Address:
112 W PARK AVE
ASH FORK, AZ
ZIP 86320
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Facility Phone Number: 855 277-5901

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1154094779

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2211864
LAB Type	Community Clinic
Facility Name	ALCHEMY APOTHECARY
Street	112 W PARK AVE
City	ASH FORK
State	AZ
ZIP	86320
Phone	855 277-5901
CertificateType	4
CertificateEffectiveDate	2/1/2023
CertificateExpirationDate	1/31/2025
FacilityType	Waiver

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