34D2142406 CLIA NUMBER - HARRIS TEETER PHARMACY #97-0353

Laboratory Demographics

  • CLIA Code: 34D2142406
  • Facility Name: HARRIS TEETER PHARMACY #97-0353
  • Facility Address: 13686 CAPITAL BOULEVARD
    WAKE FOREST, NC
    ZIP 27587
  • Facility Phone: 919 554-3226
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KYLE MATALA
  • NPI Number: 1992216220
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2142406
LAB Type Pharmacy
Facility Name HARRIS TEETER PHARMACY #97-0353
Street 13686 CAPITAL BOULEVARD
City WAKE FOREST
State NC
ZIP 27587
Phone 919 554-3226
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2024
Certificate Expiration Date 1/9/2026
Facility Type Pharmacy
Lab Director KYLE MATALA

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