34D2135031 CLIA NUMBER - EASTSIDE PHARMACY SERVICES DBA BANNER DRUG

Laboratory Demographics

  • CLIA Code: 34D2135031
  • Facility Name: EASTSIDE PHARMACY SERVICES DBA BANNER DRUG
  • Facility Address: 308A MOCKSVILLE HWY
    STATESVILLE, NC
    ZIP 28625
  • Facility Phone: 704 878-6681
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MELINDA C. CHILDRESS
  • NPI Number: 1629630348
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2135031
LAB Type Pharmacy
Facility Name EASTSIDE PHARMACY SERVICES DBA BANNER DRUG
Street 308A MOCKSVILLE HWY
City STATESVILLE
State NC
ZIP 28625
Phone 704 878-6681
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type Pharmacy
Lab Director MELINDA C. CHILDRESS

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