06D2017543 CLIA NUMBER - KING SOOPERS #104

Laboratory Demographics

  • CLIA Code: 06D2017543
  • Facility Name: KING SOOPERS #104
  • Facility Address: 1520 MAIN ST
    WINDSOR, CO
    ZIP 80550
  • Facility Phone: 970 674-2840
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIMBERLY WARD
  • NPI Number: 1124063896
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 06D2017543
LAB Type Pharmacy
Facility Name KING SOOPERS #104
Street 1520 MAIN ST
City WINDSOR
State CO
ZIP 80550
Phone 970 674-2840
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Pharmacy
Lab Director KIMBERLY WARD

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