14D0911719 CLIA NUMBER - MARYVILLE PHARMACY INC

Laboratory Demographics

  • CLIA Code: 14D0911719
  • Facility Name: MARYVILLE PHARMACY INC
  • Facility Address: 2700 NORTH CENTER STREET
    MARYVILLE, IL
    ZIP 62062
  • Facility Phone: 618 288-7474
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GARY CERETTO
  • NPI Number: 1750925079
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D0911719
LAB Type Pharmacy
Facility Name MARYVILLE PHARMACY INC
Street 2700 NORTH CENTER STREET
City MARYVILLE
State IL
ZIP 62062
Phone 618 288-7474
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/13/2024
Certificate Expiration Date 2/12/2026
Facility Type Pharmacy
Lab Director GARY CERETTO

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