34D2211377 CLIA NUMBER - MEDICINE MART LTC LLC

Laboratory Demographics

  • CLIA Code: 34D2211377
  • Facility Name: MEDICINE MART LTC LLC
  • Facility Address: 214 SOUTH MAIN
    TABOR CITY, NC
    ZIP 28463
  • Facility Phone: 910 653-6802
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STERLING G. KOONCE
  • NPI Number: 1174639041
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2211377
LAB Type Pharmacy
Facility Name MEDICINE MART LTC LLC
Street 214 SOUTH MAIN
City TABOR CITY
State NC
ZIP 28463
Phone 910 653-6802
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/27/2025
Certificate Expiration Date 1/26/2027
Facility Type Pharmacy
Lab Director STERLING G. KOONCE

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