21D2118571 CLIA NUMBER - ELLICOTT CITY PHARMACY

Laboratory Demographics

  • CLIA Code: 21D2118571
  • Facility Name: ELLICOTT CITY PHARMACY
  • Facility Address: 9338 BALTIMORE NATIONAL PIKE #11
    ELLICOTT CITY, MD
    ZIP 21042
  • Facility Phone: 410 750-1951
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JUNGEUN J. KIM
  • NPI Number: 1497041768
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2118571
LAB Type Pharmacy
Facility Name ELLICOTT CITY PHARMACY
Street 9338 BALTIMORE NATIONAL PIKE #11
City ELLICOTT CITY
State MD
ZIP 21042
Phone 410 750-1951
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type Pharmacy
Lab Director JUNGEUN J. KIM

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