44D2189630 CLIA NUMBER - BOONES CREEK PHARMACY

Laboratory Demographics

  • CLIA Code: 44D2189630
  • Facility Name: BOONES CREEK PHARMACY
  • Facility Address: 4729 NORTH ROAN STREET STE 2
    JOHNSON CITY, TN
    ZIP 37615
  • Facility Phone: 423 283-0911
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARK A. GUIMOND
  • NPI Number: 1073940334
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D2189630
LAB Type Pharmacy
Facility Name BOONES CREEK PHARMACY
Street 4729 NORTH ROAN STREET STE 2
City JOHNSON CITY
State TN
ZIP 37615
Phone 423 283-0911
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2024
Certificate Expiration Date 8/3/2026
Facility Type Pharmacy
Lab Director MARK A. GUIMOND

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