16D0922143 CLIA NUMBER - MAIN AT LOCUST PHARMACY CLINIC AND MEDICAL SUPPLIES

Laboratory Demographics

  • CLIA Code: 16D0922143
  • Facility Name: MAIN AT LOCUST PHARMACY CLINIC AND MEDICAL SUPPLIES
  • Facility Address: 129 WEST LOCUST STREET
    DAVENPORT, IA
    ZIP 52803
  • Facility Phone: (563) 324-1641
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: LISA C. PLOEHN
  • NPI Number: 1184781940
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D0922143
LAB Type Mobile Laboratory
Facility Name MAIN AT LOCUST PHARMACY CLINIC AND MEDICAL SUPPLIES
Street 129 WEST LOCUST STREET
City DAVENPORT
State IA
ZIP 52803
Phone 5633241641
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2025
Certificate Expiration Date 10/22/2027
Facility Type Mobile Laboratory
Lab Director LISA C. PLOEHN

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