37D2064290 CLIA NUMBER - TISHOMINGO INDIAN HEALTH CLINIC PHARMACY

Laboratory Demographics

  • CLIA Code: 37D2064290
  • Facility Name: TISHOMINGO INDIAN HEALTH CLINIC PHARMACY
  • Facility Address: 817 EAST 6TH ST
    TISHOMINGO, OK
    ZIP 73460
  • Facility Phone: 580 371-2362
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON GRAY
  • NPI Number: 1134219058
  • Taxonomy: 251K00000X - Public Health or Welfare

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CLIA Record

Field Name Field Value
CLIA Number 37D2064290
LAB Type Pharmacy
Facility Name TISHOMINGO INDIAN HEALTH CLINIC PHARMACY
Street 817 EAST 6TH ST
City TISHOMINGO
State OK
ZIP 73460
Phone 580 371-2362
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2025
Certificate Expiration Date 8/16/2027
Facility Type Pharmacy
Lab Director JASON GRAY

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