31D2193360 CLIA NUMBER - KOTIYARK DBA BAYSHORE HOMECARE PHARMACY

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Laboratory Demographics

CLIA Number: 31D2193360

Facility Name: KOTIYARK DBA BAYSHORE HOMECARE PHARMACY

Facility Address:
733 N BEERS STREET SUITE L1
HOLMDEL, NJ
ZIP 07733
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Facility Phone Number: 732 888-0303

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1689660029

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	31D2193360
LAB Type	Pharmacy
Facility Name	KOTIYARK DBA BAYSHORE HOMECARE PHARMACY
Street	733 N BEERS STREET SUITE L1
City	HOLMDEL
State	NJ
ZIP	07733
Phone	732 888-0303
CertificateType	4
CertificateEffectiveDate	9/21/2022
CertificateExpirationDate	9/20/2024
FacilityType	Waiver

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