10D1053876 CLIA NUMBER - MEDICINE SHOPPE #1487, THE

Laboratory Demographics

  • CLIA Code: 10D1053876
  • Facility Name: MEDICINE SHOPPE #1487, THE
  • Facility Address: 2176 SARNO RD STE 120
    MELBOURNE, FL
    ZIP 32935
  • Facility Phone: 321 242-2440
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: CARL D. ACQUAVIVA
  • NPI Number: 1306951330
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D1053876
LAB Type Other
Facility Name MEDICINE SHOPPE #1487, THE
Street 2176 SARNO RD STE 120
City MELBOURNE
State FL
ZIP 32935
Phone 321 242-2440
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2024
Certificate Expiration Date 5/7/2026
Facility Type Other
Lab Director CARL D. ACQUAVIVA

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