06D2083465 CLIA NUMBER - KING SOOPERS PHARMACY #102

Laboratory Demographics

  • CLIA Code: 06D2083465
  • Facility Name: KING SOOPERS PHARMACY #102
  • Facility Address: 1611 PACE ST
    LONGMONT, CO
    ZIP 80501
  • Facility Phone: (303) 776-7590
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: KIMBERLY WARD
  • NPI Number: 1851336523
  • Taxonomy: 3336C0003X - Pharmacy

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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 3037767590
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2024
Certificate Expiration Date 9/4/2026
Facility Type Other - RETAIL PHARMACY
Lab Director KIMBERLY WARD

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This page was last updated on: 5/18/2026