45D2269627 CLIA NUMBER - PREMIUM FAMILY PHARMACY

Laboratory Demographics

  • CLIA Code: 45D2269627
  • Facility Name: PREMIUM FAMILY PHARMACY
  • Facility Address: 1776 TEASLEY LN SUITE 111
    DENTON, TX
    ZIP 76205
  • Facility Phone: 940 442-6767
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PATIENCE TANTOH
  • NPI Number: 1417253055
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2269627
LAB Type Pharmacy
Facility Name PREMIUM FAMILY PHARMACY
Street 1776 TEASLEY LN SUITE 111
City DENTON
State TX
ZIP 76205
Phone 940 442-6767
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/29/2024
Certificate Expiration Date 9/28/2026
Facility Type Pharmacy
Lab Director PATIENCE TANTOH

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