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45D2183818 CLIA NUMBER - SUPER 1 PHARMACY #618

Laboratory Demographics

CLIA Number: 45D2183818

Facility Name: SUPER 1 PHARMACY #618

Facility Address:
2610 RICHMOND ROAD
TEXARKANA, TX
ZIP 75503
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Facility Phone Number: 903 832-2258

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1093888562

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 45D2183818
LAB Type Pharmacy
Facility Name SUPER 1 PHARMACY #618
Street 2610 RICHMOND ROAD
City TEXARKANA
State TX
ZIP 75503
Phone 903 832-2258
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