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15D2283802 CLIA NUMBER - HOOK- SUPERX LLC DBA CVS/PHARMACY # 05408

Laboratory Demographics

CLIA Number: 15D2283802

Facility Name: HOOK- SUPERX LLC DBA CVS/PHARMACY # 05408

Facility Address:
5020 N STATE RD 135
BARGERSVILLE, IN
ZIP 46106
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Facility Phone Number: 317 535-1898

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1497911259

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 15D2283802
LAB Type Pharmacy
Facility Name HOOK- SUPERX LLC DBA CVS/PHARMACY # 05408
Street 5020 N STATE RD 135
City BARGERSVILLE
State IN
ZIP 46106
Phone 317 535-1898
CertificateType 4
CertificateEffectiveDate 6/13/2023
CertificateExpirationDate 6/12/2025
FacilityType Waiver

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