45D2176470 CLIA NUMBER - GRAND PHARMACY

Laboratory Demographics

  • CLIA Code: 45D2176470
  • Facility Name: GRAND PHARMACY
  • Facility Address: 3500 NE 24TH ST
    AMARILLO, TX
    ZIP 79107
  • Facility Phone: 806 350-7455
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARIO A. HERNANDEZ
  • NPI Number: 1730421975
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2176470
LAB Type Pharmacy
Facility Name GRAND PHARMACY
Street 3500 NE 24TH ST
City AMARILLO
State TX
ZIP 79107
Phone 806 350-7455
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2023
Certificate Expiration Date 12/15/2025
Facility Type Pharmacy
Lab Director MARIO A. HERNANDEZ

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