21D2155502 CLIA NUMBER - HARRIS TEETER PHARMACY #97-0323

Laboratory Demographics

  • CLIA Code: 21D2155502
  • Facility Name: HARRIS TEETER PHARMACY #97-0323
  • Facility Address: 8184 WESTSIDE DRIVE
    FULTON, MD
    ZIP 20759
  • Facility Phone: 301 362-5765
  • Facility Type: Other - PHARMACIST
  • Facility Type: Waiver
  • Lab Director: KELLEN O. RILEY
  • NPI Number: 1679806517
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2155502
LAB Type Other - PHARMACIST
Facility Name HARRIS TEETER PHARMACY #97-0323
Street 8184 WESTSIDE DRIVE
City FULTON
State MD
ZIP 20759
Phone 301 362-5765
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