16D1084120 CLIA NUMBER - MEDICAP PHARMACY GRX HOLDINGS LLC

Laboratory Demographics

  • CLIA Code: 16D1084120
  • Facility Name: MEDICAP PHARMACY GRX HOLDINGS LLC
  • Facility Address: 2105 N 3RD LANE
    INDIANOLA, IA
    ZIP 50125
  • Facility Phone: 515 961-5303
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THOMAS SMITH
  • NPI Number: 1093764086
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D1084120
LAB Type Pharmacy
Facility Name MEDICAP PHARMACY GRX HOLDINGS LLC
Street 2105 N 3RD LANE
City INDIANOLA
State IA
ZIP 50125
Phone 515 961-5303
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2024
Certificate Expiration Date 5/15/2026
Facility Type Pharmacy
Lab Director THOMAS SMITH

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