42D2066080 CLIA NUMBER - MEDICINE MART OF WEST COLUMBIA, INC

Laboratory Demographics

  • CLIA Code: 42D2066080
  • Facility Name: MEDICINE MART OF WEST COLUMBIA, INC
  • Facility Address: 1302 SUNSET BLVD
    WEST COLUMBIA, SC
    ZIP 29169
  • Facility Phone: 803 791-7043
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LYNN E. CONNELLY
  • NPI Number: 1598858987
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2066080
LAB Type Pharmacy
Facility Name MEDICINE MART OF WEST COLUMBIA, INC
Street 1302 SUNSET BLVD
City WEST COLUMBIA
State SC
ZIP 29169
Phone 803 791-7043
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2025
Certificate Expiration Date 9/19/2027
Facility Type Pharmacy
Lab Director LYNN E. CONNELLY

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