06D2017510 CLIA NUMBER - KING SOOPERS #80

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Laboratory Demographics

CLIA Number: 06D2017510

Facility Name: KING SOOPERS #80

Facility Address:
995 S HOVER ST
LONGMONT, CO
ZIP 80501
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Facility Phone Number: 303 702-0089

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1730116260

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	06D2017510
LAB Type	Pharmacy
Facility Name	KING SOOPERS #80
Street	995 S HOVER ST
City	LONGMONT
State	CO
ZIP	80501
Phone	303 702-0089
CertificateType	4
CertificateEffectiveDate	12/13/2022
CertificateExpirationDate	12/12/2024
FacilityType	Waiver

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