39D0972283 CLIA NUMBER - FAMILY MEDICINE OF EVANGELICAL-MIDDLEBURG

Laboratory Demographics

CLIA Number: 39D0972283

Facility Name: FAMILY MEDICINE OF EVANGELICAL-MIDDLEBURG

Facility Address:
412 WEST MARKET STREET
MIDDLEBURG, PA
ZIP 17842
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Facility Phone Number: 570 522-2990

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1831194000

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	39D0972283
LAB Type	Physician Office
Facility Name	FAMILY MEDICINE OF EVANGELICAL-MIDDLEBURG
Street	412 WEST MARKET STREET
City	MIDDLEBURG
State	PA
ZIP	17842
Phone	570 522-2990
CertificateType	4
CertificateEffectiveDate	10/24/2022
CertificateExpirationDate	10/23/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024