10D2195626 CLIA NUMBER - PINE BROOK PHARMACY LLC

Laboratory Demographics

  • CLIA Code: 10D2195626
  • Facility Name: PINE BROOK PHARMACY LLC
  • Facility Address: 14111 CORTEZ BLVD
    BROOKSVILLE, FL
    ZIP 34613
  • Facility Phone: 352 610-4347
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GAUTAM R. THAKKAR
  • NPI Number: 1558596932
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 10D2195626
LAB Type Pharmacy
Facility Name PINE BROOK PHARMACY LLC
Street 14111 CORTEZ BLVD
City BROOKSVILLE
State FL
ZIP 34613
Phone 352 610-4347
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/10/2024
Certificate Expiration Date 10/9/2026
Facility Type Pharmacy
Lab Director GAUTAM R. THAKKAR

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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