26D2207523 CLIA NUMBER - TARA PHARMACY SE, LLC

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Laboratory Demographics

CLIA Number: 26D2207523

Facility Name: TARA PHARMACY SE, LLC

Facility Address:
11643 LILBURN PARK RD
SAINT LOUIS, MO
ZIP 63146
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Facility Phone Number: 314 567-7239

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1720218506

Taxonomy: 3336L0003X - Pharmacy
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

CLIA Record

Field Name	Field Value
CLIA Number	26D2207523
LAB Type	Pharmacy
Facility Name	TARA PHARMACY SE, LLC
Street	11643 LILBURN PARK RD
City	SAINT LOUIS
State	MO
ZIP	63146
Phone	314 567-7239
CertificateType	4
CertificateEffectiveDate	12/29/2022
CertificateExpirationDate	12/28/2024
FacilityType	Waiver

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