34D2324191 CLIA NUMBER - KENANSVILLE PHARMACY

Laboratory Demographics

  • CLIA Code: 34D2324191
  • Facility Name: KENANSVILLE PHARMACY
  • Facility Address: 134 B LIBERTY SQUARE SHOPPING CENTER
    KENANSVILLE, NC
    ZIP 28349
  • Facility Phone: 920 296-0500
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ASHLEY B. EZZELL
  • NPI Number: 1750004800
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D2324191
LAB Type Pharmacy
Facility Name KENANSVILLE PHARMACY
Street 134 B LIBERTY SQUARE SHOPPING CENTER
City KENANSVILLE
State NC
ZIP 28349
Phone 920 296-0500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2025
Certificate Expiration Date 5/19/2027
Facility Type Pharmacy
Lab Director ASHLEY B. EZZELL

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