41D2119658 CLIA NUMBER - ELECTRIC BOAT FAMILY PHARMACY

Laboratory Demographics

  • CLIA Code: 41D2119658
  • Facility Name: ELECTRIC BOAT FAMILY PHARMACY
  • Facility Address: 100 ROMANO VINEYARD WAY
    NORTH KINGSTOWN, RI
    ZIP 02852
  • Facility Phone: 401 295-5791
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EDWARD G. MISTO
  • NPI Number: 1194919597
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 41D2119658
LAB Type Pharmacy
Facility Name ELECTRIC BOAT FAMILY PHARMACY
Street 100 ROMANO VINEYARD WAY
City NORTH KINGSTOWN
State RI
ZIP 02852
Phone 401 295-5791
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2024
Certificate Expiration Date 10/2/2026
Facility Type Pharmacy
Lab Director EDWARD G. MISTO

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