14D1077751 CLIA NUMBER - HY-VEE PHARMACY (1415)

Laboratory Demographics

  • CLIA Code: 14D1077751
  • Facility Name: HY-VEE PHARMACY (1415)
  • Facility Address: 201 W 10TH AVE
    MILAN, IL
    ZIP 61264
  • Facility Phone: 515 559-5708
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELSEY PAYSEN
  • NPI Number: 1821027616
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1077751
LAB Type Pharmacy
Facility Name HY-VEE PHARMACY (1415)
Street 201 W 10TH AVE
City MILAN
State IL
ZIP 61264
Phone 515 559-5708
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2023
Certificate Expiration Date 12/17/2025
Facility Type Pharmacy
Lab Director KELSEY PAYSEN

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