51D1048579 CLIA NUMBER - FRUTH PHARMACY #23

Laboratory Demographics

  • CLIA Code: 51D1048579
  • Facility Name: FRUTH PHARMACY #23
  • Facility Address: 4012 TEAYS VALLEY ROAD
    SCOTT DEPOT, WV
    ZIP 25560
  • Facility Phone: 304 201-1630
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHARLES D. MASSEY
  • NPI Number: 1427063361
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D1048579
LAB Type Pharmacy
Facility Name FRUTH PHARMACY #23
Street 4012 TEAYS VALLEY ROAD
City SCOTT DEPOT
State WV
ZIP 25560
Phone 304 201-1630
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/6/2023
Certificate Expiration Date 12/5/2025
Facility Type Pharmacy
Lab Director CHARLES D. MASSEY

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