45D2152559 CLIA NUMBER - KELLY DRUG, INC

Laboratory Demographics

  • CLIA Code: 45D2152559
  • Facility Name: KELLY DRUG, INC
  • Facility Address: 125 E BROAD STREET
    MINEOLA, TX
    ZIP 75773
  • Facility Phone: 903 569-3882
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELLY J. WILLIAMS
  • NPI Number: 1467564377
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2152559
LAB Type Pharmacy
Facility Name KELLY DRUG, INC
Street 125 E BROAD STREET
City MINEOLA
State TX
ZIP 75773
Phone 903 569-3882
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2024
Certificate Expiration Date 8/12/2026
Facility Type Pharmacy
Lab Director KELLY J. WILLIAMS

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