37D2225270 CLIA NUMBER - MAIN STREET DRUG

Laboratory Demographics

  • CLIA Code: 37D2225270
  • Facility Name: MAIN STREET DRUG
  • Facility Address: 225 W MAIN ST
    WILBURTON, OK
    ZIP 74578
  • Facility Phone: 918 465-9300
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DARREN TIDWELL
  • NPI Number: 1629007893
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 37D2225270
LAB Type Pharmacy
Facility Name MAIN STREET DRUG
Street 225 W MAIN ST
City WILBURTON
State OK
ZIP 74578
Phone 918 465-9300
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 DARREN TIDWELL

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