45D2150645 CLIA NUMBER - MARKET STREET PHARMACY #696

Laboratory Demographics

  • CLIA Code: 45D2150645
  • Facility Name: MARKET STREET PHARMACY #696
  • Facility Address: 3145 E BROAD ST
    MANSFIELD, TX
    ZIP 76063
  • Facility Phone: 817 453-6015
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SARA PANNELL
  • NPI Number: 1578074985
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2150645
LAB Type Pharmacy
Facility Name MARKET STREET PHARMACY #696
Street 3145 E BROAD ST
City MANSFIELD
State TX
ZIP 76063
Phone 817 453-6015
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2024
Certificate Expiration Date 6/28/2026
Facility Type Pharmacy
Lab Director SARA PANNELL

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