10D2159407 CLIA NUMBER - MANGO PHARMACY LLC

Laboratory Demographics

  • CLIA Code: 10D2159407
  • Facility Name: MANGO PHARMACY LLC
  • Facility Address: 11509 E MLK JR BLVD
    MANGO, FL
    ZIP 33550
  • Facility Phone: 813 661-2263
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUKETU PATEL
  • NPI Number: 1669785168
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2159407
LAB Type Pharmacy
Facility Name MANGO PHARMACY LLC
Street 11509 E MLK JR BLVD
City MANGO
State FL
ZIP 33550
Phone 813 661-2263
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2024
Certificate Expiration Date 12/17/2026
Facility Type Pharmacy
Lab Director SUKETU PATEL

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