21D2113138 CLIA NUMBER - GIANT PHARMACY #166

Laboratory Demographics

  • CLIA Code: 21D2113138
  • Facility Name: GIANT PHARMACY #166
  • Facility Address: 4622 WILKENS AVE
    BALTIMORE, MD
    ZIP 21229
  • Facility Phone: 410 247-5802
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL ZOOK
  • NPI Number: 1962435214
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2113138
LAB Type Pharmacy
Facility Name GIANT PHARMACY #166
Street 4622 WILKENS AVE
City BALTIMORE
State MD
ZIP 21229
Phone 410 247-5802
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/17/2024
Certificate Expiration Date 5/16/2026
Facility Type Pharmacy
Lab Director MICHAEL ZOOK

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This page was last updated on: 6/4/2025