20D2241363 CLIA NUMBER - SPRUCE MOUNTAIN PHARMACY

Laboratory Demographics

  • CLIA Code: 20D2241363
  • Facility Name: SPRUCE MOUNTAIN PHARMACY
  • Facility Address: 148 MAIN STREET
    JAY, ME
    ZIP 04239
  • Facility Phone: 207 897-9080
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHEN J. MAKI
  • NPI Number: 1831337088
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2241363
LAB Type Pharmacy
Facility Name SPRUCE MOUNTAIN PHARMACY
Street 148 MAIN STREET
City JAY
State ME
ZIP 04239
Phone 207 897-9080
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2023
Certificate Expiration Date 10/26/2025
Facility Type Pharmacy
Lab Director STEPHEN J. MAKI

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