50D2254898 CLIA NUMBER - HAWKS PRAIRE HEALTH MART PHARMACY

Laboratory Demographics

  • CLIA Code: 50D2254898
  • Facility Name: HAWKS PRAIRE HEALTH MART PHARMACY
  • Facility Address: 2539 MARVIN RD NE STE E
    LACEY, WA
    ZIP 98516
  • Facility Phone: 360 438-3072
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUNIL THIMMEGROWDA
  • NPI Number: 1508292707
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2254898
LAB Type Pharmacy
Facility Name HAWKS PRAIRE HEALTH MART PHARMACY
Street 2539 MARVIN RD NE STE E
City LACEY
State WA
ZIP 98516
Phone 360 438-3072
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2022
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director SUNIL THIMMEGROWDA

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