45D2321264 CLIA NUMBER - PRIME REVIVAL RESEARCH

Laboratory Demographics

  • CLIA Code: 45D2321264
  • Facility Name: PRIME REVIVAL RESEARCH
  • Facility Address: 215 S DENTON TAP ROAD SUITE 275
    COPPELL, TX
    ZIP 75019
  • Facility Phone: 214 432-1198
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FARHANA KAZI
  • NPI Number: 1487156139
  • Taxonomy: 207RG0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2321264
LAB Type Physician Office
Facility Name PRIME REVIVAL RESEARCH
Street 215 S DENTON TAP ROAD SUITE 275
City COPPELL
State TX
ZIP 75019
Phone 214 432-1198
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type Physician Office
Lab Director FARHANA KAZI

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