51D2326037 CLIA NUMBER - RENEGADE PHARMACY, INC

Laboratory Demographics

  • CLIA Code: 51D2326037
  • Facility Name: RENEGADE PHARMACY, INC
  • Facility Address: 18 LOGAN STREET
    OCEANA, WV
    ZIP 24870
  • Facility Phone: 304 682-0444
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEVONNA MILLER-WEST
  • NPI Number: 1154977023
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D2326037
LAB Type Pharmacy
Facility Name RENEGADE PHARMACY, INC
Street 18 LOGAN STREET
City OCEANA
State WV
ZIP 24870
Phone 304 682-0444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2025
Certificate Expiration Date 6/24/2027
Facility Type Pharmacy
Lab Director DEVONNA MILLER-WEST

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