07D2119191 CLIA NUMBER - MAIN STREET PHARMACY

Laboratory Demographics

  • CLIA Code: 07D2119191
  • Facility Name: MAIN STREET PHARMACY
  • Facility Address: 2117 BOSTON AVE
    BRIDGEPORT, CT
    ZIP 06610
  • Facility Phone: (203) 212-3800
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEAN K. JACOB
  • NPI Number: 1316249352
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 07D2119191
LAB Type Pharmacy
Facility Name MAIN STREET PHARMACY
Street 2117 BOSTON AVE
City BRIDGEPORT
State CT
ZIP 06610
Phone 2032123800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2024
Certificate Expiration Date 9/20/2026
Facility Type Pharmacy
Lab Director JEAN K. JACOB

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This page was last updated on: 5/18/2026