14D2182519 CLIA NUMBER - MT VERNON COMMUNITY PHARMACY

Laboratory Demographics

  • CLIA Code: 14D2182519
  • Facility Name: MT VERNON COMMUNITY PHARMACY
  • Facility Address: 2339 BROADWAY
    MOUNT VERNON, IL
    ZIP 62864
  • Facility Phone: 618 242-8776
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC L. BLACK
  • NPI Number: 1417923012
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2182519
LAB Type Pharmacy
Facility Name MT VERNON COMMUNITY PHARMACY
Street 2339 BROADWAY
City MOUNT VERNON
State IL
ZIP 62864
Phone 618 242-8776
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/22/2024
Certificate Expiration Date 4/21/2026
Facility Type Pharmacy
Lab Director ERIC L. BLACK

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