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15D2283676 CLIA NUMBER - HOOK-SUPERX LLC DBA CVS/PHARMACY #06677

Laboratory Demographics

CLIA Number: 15D2283676

Facility Name: HOOK-SUPERX LLC DBA CVS/PHARMACY #06677

Facility Address:
3630 S 18TH ST
LAFAYETTE, IN
ZIP 47909
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Facility Phone Number: 765 474-3834

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1285737791

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 15D2283676
LAB Type Pharmacy
Facility Name HOOK-SUPERX LLC DBA CVS/PHARMACY #06677
Street 3630 S 18TH ST
City LAFAYETTE
State IN
ZIP 47909
Phone 765 474-3834
CertificateType 4
CertificateEffectiveDate 6/12/2023
CertificateExpirationDate 6/11/2025
FacilityType Waiver

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