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23D2182829 CLIA NUMBER - COUNTRY MARKET PHARMACY #11

Laboratory Demographics

CLIA Number: 23D2182829

Facility Name: COUNTRY MARKET PHARMACY #11

Facility Address:
1535 MAUMEE STREET
ADRIAN, MI
ZIP 49221
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Facility Phone Number: 517 265-9162

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1285167635

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 23D2182829
LAB Type Pharmacy
Facility Name COUNTRY MARKET PHARMACY #11
Street 1535 MAUMEE STREET
City ADRIAN
State MI
ZIP 49221
Phone 517 265-9162
CertificateType 4
CertificateEffectiveDate 4/27/2024
CertificateExpirationDate 4/26/2026
FacilityType Waiver

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