11D2188249 CLIA NUMBER - LAKE PARK PHARMACY DBA CHANCY DRUGS

Laboratory Demographics

  • CLIA Code: 11D2188249
  • Facility Name: LAKE PARK PHARMACY DBA CHANCY DRUGS
  • Facility Address: 453 LAKES BOULEVARD
    LAKE PARK, GA
    ZIP 31636
  • Facility Phone: 229 559-9394
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WENDY A. DORMINEY
  • NPI Number: 1508964537
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2188249
LAB Type Pharmacy
Facility Name LAKE PARK PHARMACY DBA CHANCY DRUGS
Street 453 LAKES BOULEVARD
City LAKE PARK
State GA
ZIP 31636
Phone 229 559-9394
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/15/2024
Certificate Expiration Date 7/14/2026
Facility Type Pharmacy
Lab Director WENDY A. DORMINEY

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