19D2182646 CLIA NUMBER - CRESCENT CITY PHARMACY LMF VENTURES, LLC

Laboratory Demographics

CLIA Number: 19D2182646

Facility Name: CRESCENT CITY PHARMACY LMF VENTURES, LLC

Facility Address:
2240 SIMON BOLIVAR AVE, STE A
NEW ORLEANS, LA
ZIP 70113
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Facility Phone Number: 504 267-4100

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093081036

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2182646
LAB Type	Pharmacy
Facility Name	CRESCENT CITY PHARMACY LMF VENTURES, LLC
Street	2240 SIMON BOLIVAR AVE, STE A
City	NEW ORLEANS
State	LA
ZIP	70113
Phone	504 267-4100
CertificateType	4
CertificateEffectiveDate	4/24/2024
CertificateExpirationDate	4/23/2026
FacilityType	Waiver

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