06D2287751 CLIA NUMBER - PALISADE PHARMACY

Laboratory Demographics

CLIA Number: 06D2287751

Facility Name: PALISADE PHARMACY

Facility Address:
707 ELBERTA AVE, SUITE B
PALISADE, CO
ZIP 81526
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Facility Phone Number: 970 464-5669

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1275024739

Taxonomy: 385H00000X - Respite Care

CLIA Record

Field Name	Field Value
CLIA Number	06D2287751
LAB Type	Pharmacy
Facility Name	PALISADE PHARMACY
Street	707 ELBERTA AVE, SUITE B
City	PALISADE
State	CO
ZIP	81526
Phone	970 464-5669
CertificateType	4
CertificateEffectiveDate	8/17/2023
CertificateExpirationDate	8/16/2025
FacilityType	Waiver

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