16D1084120 CLIA NUMBER - MEDICAP PHARMACY GRX HOLDINGS LLC

Laboratory Demographics

CLIA Number: 16D1084120

Facility Name: MEDICAP PHARMACY GRX HOLDINGS LLC

Facility Address:
2105 N 3RD LANE
INDIANOLA, IA
ZIP 50125
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Facility Phone Number: 515 961-5303

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093764086

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

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
CertificateType	4
CertificateEffectiveDate	5/16/2024
CertificateExpirationDate	5/15/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024