15D2222176 CLIA NUMBER - HOOK-SUPERX, LLC DBA CVS/PHARMACY #06509

Laboratory Demographics

CLIA Number: 15D2222176

Facility Name: HOOK-SUPERX, LLC DBA CVS/PHARMACY #06509

Facility Address:
2802 EAST STATE BOULEVARD
FORT WAYNE, IN
ZIP 46805
Get Directions

Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1245330554

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	15D2222176
LAB Type	Pharmacy
Facility Name	HOOK-SUPERX, LLC DBA CVS/PHARMACY #06509
Street	2802 EAST STATE BOULEVARD
City	FORT WAYNE
State	IN
ZIP	46805
Phone	401 770-6431
CertificateType	4
CertificateEffectiveDate	4/27/2023
CertificateExpirationDate	4/26/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

This page was last updated on: 4/23/2024