49D1061142 CLIA NUMBER - MAIN STREET PHARMACY

Laboratory Demographics

  • CLIA Code: 49D1061142
  • Facility Name: MAIN STREET PHARMACY
  • Facility Address: 308 N MAIN STREET
    KILMARNOCK, VA
    ZIP 22482
  • Facility Phone: 804 435-8818
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CARROLL A. THROCKMORTON
  • NPI Number: 1528016771
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D1061142
LAB Type Pharmacy
Facility Name MAIN STREET PHARMACY
Street 308 N MAIN STREET
City KILMARNOCK
State VA
ZIP 22482
Phone 804 435-8818
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2024
Certificate Expiration Date 11/8/2026
Facility Type Pharmacy
Lab Director CARROLL A. THROCKMORTON

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This page was last updated on: 6/4/2025