15D2283113 CLIA NUMBER - HOOK-SUPERX, LLC DBA CVS/PHARMACY #06574

Laboratory Demographics

CLIA Number: 15D2283113

Facility Name: HOOK-SUPERX, LLC DBA CVS/PHARMACY #06574

Facility Address:
950 SOUTH PERU ST
CICERO, IN
ZIP 46034
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Facility Phone Number: 317 984-3623

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1205939915

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	15D2283113
LAB Type	Pharmacy
Facility Name	HOOK-SUPERX, LLC DBA CVS/PHARMACY #06574
Street	950 SOUTH PERU ST
City	CICERO
State	IN
ZIP	46034
Phone	317 984-3623
CertificateType	4
CertificateEffectiveDate	6/1/2023
CertificateExpirationDate	5/31/2025
FacilityType	Waiver

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