14D0992461 CLIA NUMBER - HY-VEE PHARMACY 1416

Laboratory Demographics

  • CLIA Code: 14D0992461
  • Facility Name: HY-VEE PHARMACY 1416
  • Facility Address: 4218 AVENUE OF THE CITIES
    MOLINE, IL
    ZIP 61265
  • Facility Phone: 309 762-0200
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CARISSA BULL PHARMD
  • NPI Number: 1346279130
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D0992461
LAB Type Pharmacy
Facility Name HY-VEE PHARMACY 1416
Street 4218 AVENUE OF THE CITIES
City MOLINE
State IL
ZIP 61265
Phone 309 762-0200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/17/2025
Certificate Expiration Date 10/16/2027
Facility Type Pharmacy
Lab Director CARISSA BULL PHARMD

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