10D2168917 CLIA NUMBER - PICH KTM CORP DBA MEDTOWN PHARMACY

Laboratory Demographics

  • CLIA Code: 10D2168917
  • Facility Name: PICH KTM CORP DBA MEDTOWN PHARMACY
  • Facility Address: 11643 BEACH BLVD UNIT A
    JACKSONVILLE, FL
    ZIP 32246
  • Facility Phone: 904 551-5870
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NAKRY S. OEUR
  • NPI Number: 1043626153
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2168917
LAB Type Pharmacy
Facility Name PICH KTM CORP DBA MEDTOWN PHARMACY
Street 11643 BEACH BLVD UNIT A
City JACKSONVILLE
State FL
ZIP 32246
Phone 904 551-5870
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2025
Certificate Expiration Date 7/10/2027
Facility Type Pharmacy
Lab Director NAKRY S. OEUR

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