20D2156452 CLIA NUMBER - ST JOHN VALLEY PHARMACY

Laboratory Demographics

  • CLIA Code: 20D2156452
  • Facility Name: ST JOHN VALLEY PHARMACY
  • Facility Address: 182 MARKET STREET, STE 2
    FORT KENT, ME
    ZIP 04743
  • Facility Phone: 207 834-2880
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMY PELLETIER
  • NPI Number: 1518481134
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2156452
LAB Type Pharmacy
Facility Name ST JOHN VALLEY PHARMACY
Street 182 MARKET STREET, STE 2
City FORT KENT
State ME
ZIP 04743
Phone 207 834-2880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2024
Certificate Expiration Date 10/17/2026
Facility Type Pharmacy
Lab Director AMY PELLETIER

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