39D2206967 CLIA NUMBER - SUBURBAN BUSTLETON PHARMACY DBA SUBURBANS PHARMACY

Laboratory Demographics

  • CLIA Code: 39D2206967
  • Facility Name: SUBURBAN BUSTLETON PHARMACY DBA SUBURBANS PHARMACY
  • Facility Address: 10875 BUSTLETON AVE
    PHILA, PA
    ZIP 19116
  • Facility Phone: 215 673-0994
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LENNY FOX
  • NPI Number: 1962560565
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 39D2206967
LAB Type Pharmacy
Facility Name SUBURBAN BUSTLETON PHARMACY DBA SUBURBANS PHARMACY
Street 10875 BUSTLETON AVE
City PHILA
State PA
ZIP 19116
Phone 215 673-0994
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2024
Certificate Expiration Date 12/22/2026
Facility Type Pharmacy
Lab Director LENNY FOX

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