06D2083465 CLIA NUMBER - KING SOOPERS PHARMACY #102

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Laboratory Demographics

CLIA Number: 06D2083465

Facility Name: KING SOOPERS PHARMACY #102

Facility Address:
1611 PACE ST
LONGMONT, CO
ZIP 80501
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Facility Phone Number: 303 776-7590

Facility Type: Other - RETAIL PHARMACY

Certificate Type: Waiver

NPI Number: 1851336523

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	06D2083465
LAB Type	Other - RETAIL PHARMACY
Facility Name	KING SOOPERS PHARMACY #102
Street	1611 PACE ST
City	LONGMONT
State	CO
ZIP	80501
Phone	303 776-7590
CertificateType	4
CertificateEffectiveDate	9/5/2022
CertificateExpirationDate	9/4/2024
FacilityType	Waiver

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