45D1071624 CLIA NUMBER - HEB PHARMACY # 019

Laboratory Demographics

  • CLIA Code: 45D1071624
  • Facility Name: HEB PHARMACY # 019
  • Facility Address: 19337 MCDONALD STREET
    LYTLE, TX
    ZIP 78052
  • Facility Phone: 210 938-8915
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUELINE GROHMAN
  • NPI Number: 1235248659
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1071624
LAB Type Pharmacy
Facility Name HEB PHARMACY # 019
Street 19337 MCDONALD STREET
City LYTLE
State TX
ZIP 78052
Phone 210 938-8915
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Pharmacy
Lab Director JACQUELINE GROHMAN

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