21D2155485 CLIA NUMBER - HARRIS TEETER PHARMACY #97-0392

Laboratory Demographics

  • CLIA Code: 21D2155485
  • Facility Name: HARRIS TEETER PHARMACY #97-0392
  • Facility Address: 3779 BOSTON STREET
    BALTIMORE, MD
    ZIP 21224
  • Facility Phone: 410 522-0804
  • Facility Type: Other - PHARMACIST
  • Facility Type: Waiver
  • Lab Director: KELLEN O. RILEY
  • NPI Number: 1760805931
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2155485
LAB Type Other - PHARMACIST
Facility Name HARRIS TEETER PHARMACY #97-0392
Street 3779 BOSTON STREET
City BALTIMORE
State MD
ZIP 21224
Phone 410 522-0804
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Other - PHARMACIST
Lab Director KELLEN O. RILEY

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