10D2163014 CLIA NUMBER - ST CLOUD COMPOUNDING PHARMACY & WELLNESS CENTER

Laboratory Demographics

  • CLIA Code: 10D2163014
  • Facility Name: ST CLOUD COMPOUNDING PHARMACY & WELLNESS CENTER
  • Facility Address: 2801 13TH ST
    SAINT CLOUD, FL
    ZIP 34769
  • Facility Phone: 407 979-4859
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SIBY PUTHENPURAYIL
  • NPI Number: 1457509531
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 10D2163014
LAB Type Pharmacy
Facility Name ST CLOUD COMPOUNDING PHARMACY & WELLNESS CENTER
Street 2801 13TH ST
City SAINT CLOUD
State FL
ZIP 34769
Phone 407 979-4859
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2025
Certificate Expiration Date 3/5/2027
Facility Type Pharmacy
Lab Director SIBY PUTHENPURAYIL

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