49D2188856 CLIA NUMBER - SPARTAN DRUG

Laboratory Demographics

CLIA Number: 49D2188856

Facility Name: SPARTAN DRUG

Facility Address:
201 LAUREL AVE
COEBURN, VA
ZIP 24230
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Facility Phone Number: 276 807-7106

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1447736152

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	49D2188856
LAB Type	Pharmacy
Facility Name	SPARTAN DRUG
Street	201 LAUREL AVE
City	COEBURN
State	VA
ZIP	24230
Phone	276 807-7106
CertificateType	4
CertificateEffectiveDate	7/23/2022
CertificateExpirationDate	7/22/2024
FacilityType	Waiver

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