06D2017563 CLIA NUMBER - CITY MARKET #417

Laboratory Demographics

  • CLIA Code: 06D2017563
  • Facility Name: CITY MARKET #417
  • Facility Address: 1703 FREMONT DR
    CANON CITY, CO
    ZIP 81212
  • Facility Phone: 719 275-3319
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIMBERLY WARD
  • NPI Number: 1134155484
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 06D2017563
LAB Type Pharmacy
Facility Name CITY MARKET #417
Street 1703 FREMONT DR
City CANON CITY
State CO
ZIP 81212
Phone 719 275-3319
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: 6/4/2025