20D2185975 CLIA NUMBER - NORTHERN LIGHT PHARMACY STATE STREET

Laboratory Demographics

  • CLIA Code: 20D2185975
  • Facility Name: NORTHERN LIGHT PHARMACY STATE STREET
  • Facility Address: 364 STATE STREET
    BANGOR, ME
    ZIP 04401
  • Facility Phone: 207 947-8369
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW J. MARSTON
  • NPI Number: 1649281155
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2185975
LAB Type Pharmacy
Facility Name NORTHERN LIGHT PHARMACY STATE STREET
Street 364 STATE STREET
City BANGOR
State ME
ZIP 04401
Phone 207 947-8369
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2024
Certificate Expiration Date 6/10/2026
Facility Type Pharmacy
Lab Director MATTHEW J. MARSTON

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