10D2189527 CLIA NUMBER - CRAYTON MITCHELL GROUP LLC DBA, THE SPACE COAST COMMUNITY PHARMACY

Laboratory Demographics

  • CLIA Code: 10D2189527
  • Facility Name: CRAYTON MITCHELL GROUP LLC DBA, THE SPACE COAST COMMUNITY PHARMACY
  • Facility Address: 197 BOUGANVILLEA DRIVE SUITE D
    ROCKLEDGE, FL
    ZIP 32955
  • Facility Phone: 321 636-2275
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRACI J. MITCHELL
  • NPI Number: 1851750178
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2189527
LAB Type Pharmacy
Facility Name CRAYTON MITCHELL GROUP LLC DBA, THE SPACE COAST COMMUNITY PHARMACY
Street 197 BOUGANVILLEA DRIVE SUITE D
City ROCKLEDGE
State FL
ZIP 32955
Phone 321 636-2275
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2024
Certificate Expiration Date 7/31/2026
Facility Type Pharmacy
Lab Director TRACI J. MITCHELL

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