19D2186394 CLIA NUMBER - EXPRESS RX OF LAKE PROVIDENCE

Laboratory Demographics

  • CLIA Code: 19D2186394
  • Facility Name: EXPRESS RX OF LAKE PROVIDENCE
  • Facility Address: 303 N HOOD STREET
    LAKE PROVIDENCE, LA
    ZIP 71254
  • Facility Phone: 318 559-2433
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC CRUMBAUGH
  • NPI Number: 1700436706
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2186394
LAB Type Pharmacy
Facility Name EXPRESS RX OF LAKE PROVIDENCE
Street 303 N HOOD STREET
City LAKE PROVIDENCE
State LA
ZIP 71254
Phone 318 559-2433
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/16/2024
Certificate Expiration Date 6/15/2026
Facility Type Pharmacy
Lab Director ERIC CRUMBAUGH

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This page was last updated on: 9/29/2025