11D2241746 CLIA NUMBER - MPT PHARMACY LLC DBA JACKSON PHARMACY

Laboratory Demographics

  • CLIA Code: 11D2241746
  • Facility Name: MPT PHARMACY LLC DBA JACKSON PHARMACY
  • Facility Address: 170 JOHN RANDOLPH DRIVE
    HOSCHTON, GA
    ZIP 30548
  • Facility Phone: 706 658-0064
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROSS D. RAINEY
  • NPI Number: 1073922670
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2241746
LAB Type Pharmacy
Facility Name MPT PHARMACY LLC DBA JACKSON PHARMACY
Street 170 JOHN RANDOLPH DRIVE
City HOSCHTON
State GA
ZIP 30548
Phone 706 658-0064
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Pharmacy
Lab Director ROSS D. RAINEY

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