19D2235127 CLIA NUMBER - PARK PHARMACY

Laboratory Demographics

  • CLIA Code: 19D2235127
  • Facility Name: PARK PHARMACY
  • Facility Address: 4811 AMBASSADOR CAFFERY PKWY, SUITE 101
    LAFAYETTE, LA
    ZIP 70508
  • Facility Phone: 337 806-9000
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHANE PRIMEAUX
  • NPI Number: 1619385812
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2235127
LAB Type Pharmacy
Facility Name PARK PHARMACY
Street 4811 AMBASSADOR CAFFERY PKWY, SUITE 101
City LAFAYETTE
State LA
ZIP 70508
Phone 337 806-9000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/7/2025
Certificate Expiration Date 9/6/2027
Facility Type Pharmacy
Lab Director SHANE PRIMEAUX

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