21D2155495 CLIA NUMBER - HARRIS TEETER PHARMACY #97-0487

Laboratory Demographics

  • CLIA Code: 21D2155495
  • Facility Name: HARRIS TEETER PHARMACY #97-0487
  • Facility Address: 44900 ST ANDREWS CHURCH ROAD
    CALIFORNIA, MD
    ZIP 20619
  • Facility Phone: 301 737-2518
  • Facility Type: Other - PHARMACY
  • Facility Type: Waiver
  • Lab Director: KELLEN O. RILEY
  • NPI Number: 1477063782
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2155495
LAB Type Other - PHARMACY
Facility Name HARRIS TEETER PHARMACY #97-0487
Street 44900 ST ANDREWS CHURCH ROAD
City CALIFORNIA
State MD
ZIP 20619
Phone 301 737-2518
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

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