34D2190397 CLIA NUMBER - MEDIPACK PHARMACY

Laboratory Demographics

  • CLIA Code: 34D2190397
  • Facility Name: MEDIPACK PHARMACY
  • Facility Address: 3917 WESTPOINT BLVD, STE A
    WINSTON-SALEM, NC
    ZIP 27103
  • Facility Phone: 336 773-1013
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RICHARD J. WHITESELL
  • NPI Number: 1265459614
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2190397
LAB Type Pharmacy
Facility Name MEDIPACK PHARMACY
Street 3917 WESTPOINT BLVD, STE A
City WINSTON-SALEM
State NC
ZIP 27103
Phone 336 773-1013
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2024
Certificate Expiration Date 8/12/2026
Facility Type Pharmacy
Lab Director RICHARD J. WHITESELL

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