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19D2167870 CLIA NUMBER - OUR LADY OD THE LAKE DERMATOLOGY

Laboratory Demographics

CLIA Number: 19D2167870

Facility Name: OUR LADY OD THE LAKE DERMATOLOGY

Facility Address:
7855 JEFFERSON HWY
BATON ROUGE, LA
ZIP 70809
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Facility Phone Number: 225 241-8011

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1740847771

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 19D2167870
LAB Type Physician Office
Facility Name OUR LADY OD THE LAKE DERMATOLOGY
Street 7855 JEFFERSON HWY
City BATON ROUGE
State LA
ZIP 70809
Phone 225 241-8011
CertificateType 3
CertificateEffectiveDate 6/17/2023
CertificateExpirationDate 6/16/2025
FacilityType PPMP

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