16D1077862 CLIA NUMBER - HY-VEE MAINSTREET #7070

Laboratory Demographics

  • CLIA Code: 16D1077862
  • Facility Name: HY-VEE MAINSTREET #7070
  • Facility Address: 2611 PIERCE STREET
    SIOUX CITY, IA
    ZIP 51104
  • Facility Phone: 712 258-0117
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRAD C. TOBEN
  • NPI Number: 1780629162
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D1077862
LAB Type Pharmacy
Facility Name HY-VEE MAINSTREET #7070
Street 2611 PIERCE STREET
City SIOUX CITY
State IA
ZIP 51104
Phone 712 258-0117
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2023
Certificate Expiration Date 12/19/2025
Facility Type Pharmacy
Lab Director BRAD C. TOBEN

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This page was last updated on: 6/4/2025