45D1101487 CLIA NUMBER - GRACE CLINIC OF LUBBOCK

Laboratory Demographics

CLIA Number: 45D1101487

Facility Name: GRACE CLINIC OF LUBBOCK

Facility Address:
4515 MARSHA SHARP FREEWAY
LUBBOCK, TX
ZIP 79407
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Facility Phone Number: 806 744-7223

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1144303264

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	45D1101487
LAB Type	Physician Office
Facility Name	GRACE CLINIC OF LUBBOCK
Street	4515 MARSHA SHARP FREEWAY
City	LUBBOCK
State	TX
ZIP	79407
Phone	806 744-7223
CertificateType	4
CertificateEffectiveDate	6/26/2023
CertificateExpirationDate	6/25/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024