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45D2183806 CLIA NUMBER - SUPER 1 PHARMACY # 610

Laboratory Demographics

CLIA Number: 45D2183806

Facility Name: SUPER 1 PHARMACY # 610

Facility Address:
1105 E GENTRY PARKWAY
TYLER, TX
ZIP 75702
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Facility Phone Number: 903 535-9467

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1790858025

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 45D2183806
LAB Type Pharmacy
Facility Name SUPER 1 PHARMACY # 610
Street 1105 E GENTRY PARKWAY
City TYLER
State TX
ZIP 75702
Phone 903 535-9467
CertificateType 4
CertificateEffectiveDate 5/11/2022
CertificateExpirationDate 5/10/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024