45D0926596 CLIA NUMBER - OLD CORNER DRUG

Laboratory Demographics

  • CLIA Code: 45D0926596
  • Facility Name: OLD CORNER DRUG
  • Facility Address: 200 N MAIN
    WEST, TX
    ZIP 76691
  • Facility Phone: 254 826-5122
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AVERY K. WINES
  • NPI Number: 1518042803
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D0926596
LAB Type Pharmacy
Facility Name OLD CORNER DRUG
Street 200 N MAIN
City WEST
State TX
ZIP 76691
Phone 254 826-5122
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/7/2024
Certificate Expiration Date 10/6/2026
Facility Type Pharmacy
Lab Director AVERY K. WINES

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