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

Laboratory Demographics

  • CLIA Code: 21D2185750
  • Facility Name: EMPIRE PROFESSIONAL PHARMACY, INC DBA EMPIRE PROFE
  • Facility Address: 200 HOSPITAL DRIVE #107
    GLEN BURNIE, MD
    ZIP 21061
  • Facility Phone: 410 787-0030
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEREMY CUNDIFF
  • NPI Number: 1902334113
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2024
Certificate Expiration Date 6/8/2026
Facility Type Pharmacy
Lab Director JEREMY CUNDIFF

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