21D2155503 CLIA NUMBER - HARRIS TEETER PHARMACY #97-0380

Laboratory Demographics

  • CLIA Code: 21D2155503
  • Facility Name: HARRIS TEETER PHARMACY #97-0380
  • Facility Address: 28528 MARLBORO AVENUE
    EASTON, MD
    ZIP 21601
  • Facility Phone: 410 690-7207
  • Facility Type: Other - PHARMACY
  • Facility Type: Waiver
  • Lab Director: KELLEN O. RILEY
  • NPI Number: 1033565486
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2155503
LAB Type Other - PHARMACY
Facility Name HARRIS TEETER PHARMACY #97-0380
Street 28528 MARLBORO AVENUE
City EASTON
State MD
ZIP 21601
Phone 410 690-7207
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