11D2172728 CLIA NUMBER - NICHOLLS PHARMACY, LLC

Laboratory Demographics

  • CLIA Code: 11D2172728
  • Facility Name: NICHOLLS PHARMACY, LLC
  • Facility Address: 1003 VAN STREAT HWY
    NICHOLLS, GA
    ZIP 31554
  • Facility Phone: 912 345-1021
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAN G. SCOTT
  • NPI Number: 1184748808
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2172728
LAB Type Pharmacy
Facility Name NICHOLLS PHARMACY, LLC
Street 1003 VAN STREAT HWY
City NICHOLLS
State GA
ZIP 31554
Phone 912 345-1021
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/30/2025
Certificate Expiration Date 9/29/2027
Facility Type Pharmacy
Lab Director JAN G. SCOTT

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