45D2172780 CLIA NUMBER - PEDIATRIC DEPOT

Laboratory Demographics

  • CLIA Code: 45D2172780
  • Facility Name: PEDIATRIC DEPOT
  • Facility Address: 1446 WEST MOORE AVE #206
    TERRELL, TX
    ZIP 75160
  • Facility Phone: 614 946-7674
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ROSHNI PATEL
  • NPI Number: 1861043259
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D2172780
LAB Type Practitioner Other
Facility Name PEDIATRIC DEPOT
Street 1446 WEST MOORE AVE #206
City TERRELL
State TX
ZIP 75160
Phone 614 946-7674
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/30/2025
Certificate Expiration Date 9/29/2027
Facility Type Practitioner Other
Lab Director ROSHNI PATEL

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