49D2198178 CLIA NUMBER - BULL RUN PROFESSIONAL PHARMACY

Laboratory Demographics

  • CLIA Code: 49D2198178
  • Facility Name: BULL RUN PROFESSIONAL PHARMACY
  • Facility Address: 9210 CHURCH ST SUITE #100RD
    MANASSAS, VA
    ZIP 20110
  • Facility Phone: 571 357-4818
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VASUMATHI VANTIKOMMU
  • NPI Number: 1881128544
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2198178
LAB Type Pharmacy
Facility Name BULL RUN PROFESSIONAL PHARMACY
Street 9210 CHURCH ST SUITE #100RD
City MANASSAS
State VA
ZIP 20110
Phone 571 357-4818
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/30/2024
Certificate Expiration Date 10/29/2026
Facility Type Pharmacy
Lab Director VASUMATHI VANTIKOMMU

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