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07D0092534 CLIA NUMBER - DEPARTMENT OF DERMATOLOGY

Laboratory Demographics

CLIA Number: 07D0092534

Facility Name: DEPARTMENT OF DERMATOLOGY

Facility Address:
21 SOUTH RD 1ST FL, STE 120
FARMINGTON, CT
ZIP 06032
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Facility Phone Number: 860 679-6685

Facility Type: Other - GOVERNMENT/MUNICIPAL

Certificate Type: Certificate of Compliance
NPI Number: 1629551759

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 07D0092534
LAB Type Other - GOVERNMENT/MUNICIPAL
Facility Name DEPARTMENT OF DERMATOLOGY
Street 21 SOUTH RD 1ST FL, STE 120
City FARMINGTON
State CT
ZIP 06032
Phone 860 679-6685
CertificateType 2
CertificateEffectiveDate 10/20/2023
CertificateExpirationDate 10/19/2025
FacilityType Compliance

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