38D2189701 CLIA NUMBER - BLACK OAK PHARMACY

Laboratory Demographics

  • CLIA Code: 38D2189701
  • Facility Name: BLACK OAK PHARMACY
  • Facility Address: 2924 SISKIYOU BLVD
    MEDFORD, OR
    ZIP 97504
  • Facility Phone: 541 773-5356
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY L. LICHLYTER
  • NPI Number: 1780738138
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2189701
LAB Type Pharmacy
Facility Name BLACK OAK PHARMACY
Street 2924 SISKIYOU BLVD
City MEDFORD
State OR
ZIP 97504
Phone 541 773-5356
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2024
Certificate Expiration Date 8/3/2026
Facility Type Pharmacy
Lab Director TIMOTHY L. LICHLYTER

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