45D0953764 CLIA NUMBER - MARKET STREET PHARMACY #517

Laboratory Demographics

  • CLIA Code: 45D0953764
  • Facility Name: MARKET STREET PHARMACY #517
  • Facility Address: 4590 KELL BLVD
    WICHITA FALLS, TX
    ZIP 76309
  • Facility Phone: 940 716-2515
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TANDY MARTIN
  • NPI Number: 1801934997
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D0953764
LAB Type Pharmacy
Facility Name MARKET STREET PHARMACY #517
Street 4590 KELL BLVD
City WICHITA FALLS
State TX
ZIP 76309
Phone 940 716-2515
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/10/2024
Certificate Expiration Date 11/9/2026
Facility Type Pharmacy
Lab Director TANDY MARTIN

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