45D2161083 CLIA NUMBER - DERAMED SPECIALTY PHARMACY

Laboratory Demographics

  • CLIA Code: 45D2161083
  • Facility Name: DERAMED SPECIALTY PHARMACY
  • Facility Address: 1001 MATLOCK RD SUITE 105
    MANSFIELD, TX
    ZIP 76063
  • Facility Phone: 817 381-3861
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ADERONKE A. EFUNOGBON
  • NPI Number: 1164997169
  • Taxonomy: 3336S0011X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2161083
LAB Type Pharmacy
Facility Name DERAMED SPECIALTY PHARMACY
Street 1001 MATLOCK RD SUITE 105
City MANSFIELD
State TX
ZIP 76063
Phone 817 381-3861
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Pharmacy
Lab Director ADERONKE A. EFUNOGBON

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