42D2288792 CLIA NUMBER - MODIFICARE LLC

Laboratory Demographics

  • CLIA Code: 42D2288792
  • Facility Name: MODIFICARE LLC
  • Facility Address: 1023A WEST DEKALD STREET
    CAMDEN, SC
    ZIP 29020
  • Facility Phone: 803 424-0064
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DENO SEBASTIAN
  • NPI Number: 1154365468
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2288792
LAB Type Pharmacy
Facility Name MODIFICARE LLC
Street 1023A WEST DEKALD STREET
City CAMDEN
State SC
ZIP 29020
Phone 803 424-0064
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2025
Certificate Expiration Date 8/30/2027
Facility Type Pharmacy
Lab Director DENO SEBASTIAN

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