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15D2282978 CLIA NUMBER - HOOK-SUPERX, LLC DBA CVS/PHARMACY #06914

Laboratory Demographics

CLIA Number: 15D2282978

Facility Name: HOOK-SUPERX, LLC DBA CVS/PHARMACY #06914

Facility Address:
5765 EAST STATE ROAD 10
DEMOTTE, IN
ZIP 46310
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Facility Phone Number: 219 345-4742

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1225131667

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 15D2282978
LAB Type Pharmacy
Facility Name HOOK-SUPERX, LLC DBA CVS/PHARMACY #06914
Street 5765 EAST STATE ROAD 10
City DEMOTTE
State IN
ZIP 46310
Phone 219 345-4742
CertificateType 4
CertificateEffectiveDate 5/30/2023
CertificateExpirationDate 5/29/2025
FacilityType Waiver

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