21D2185750 CLIA NUMBER - EMPIRE PROFESSIONAL PHARMACY, INC DBA EMPIRE PROFE

Laboratory Demographics

CLIA Number: 21D2185750

Facility Name: EMPIRE PROFESSIONAL PHARMACY, INC DBA EMPIRE PROFE

Facility Address:
200 HOSPITAL DRIVE #107
GLEN BURNIE, MD
ZIP 21061
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Facility Phone Number: 410 787-0030

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1902334113

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	21D2185750
LAB Type	Pharmacy
Facility Name	EMPIRE PROFESSIONAL PHARMACY, INC DBA EMPIRE PROFE
Street	200 HOSPITAL DRIVE #107
City	GLEN BURNIE
State	MD
ZIP	21061
Phone	410 787-0030
CertificateType	4
CertificateEffectiveDate	6/9/2022
CertificateExpirationDate	6/8/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024