15D2283490 CLIA NUMBER - HOOK-SUPERX LLC DBA CVS/PHARMACY #06673

Laboratory Demographics

CLIA Number: 15D2283490

Facility Name: HOOK-SUPERX LLC DBA CVS/PHARMACY #06673

Facility Address:
200 WEST JACKSON STREET
ATTICA, IN
ZIP 47918
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Facility Phone Number: 765 762-3390

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1477656171

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	15D2283490
LAB Type	Pharmacy
Facility Name	HOOK-SUPERX LLC DBA CVS/PHARMACY #06673
Street	200 WEST JACKSON STREET
City	ATTICA
State	IN
ZIP	47918
Phone	765 762-3390
CertificateType	4
CertificateEffectiveDate	6/8/2023
CertificateExpirationDate	6/7/2025
FacilityType	Waiver

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