21D2155487 CLIA NUMBER - HARRIS TEETER PHARMACY #97-0382

Laboratory Demographics

  • CLIA Code: 21D2155487
  • Facility Name: HARRIS TEETER PHARMACY #97-0382
  • Facility Address: 11075 RESORT ROAD
    ELLICOTT CITY, MD
    ZIP 21042
  • Facility Phone: 410 313-8215
  • Facility Type: Other - PHARMACY
  • Facility Type: Waiver
  • Lab Director: KELLEN O. RILEY
  • NPI Number: 1427396340
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 21D2155487
LAB Type Other - PHARMACY
Facility Name HARRIS TEETER PHARMACY #97-0382
Street 11075 RESORT ROAD
City ELLICOTT CITY
State MD
ZIP 21042
Phone 410 313-8215
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 - PHARMACY
Lab Director KELLEN O. RILEY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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