16D2089573 CLIA NUMBER - THRIFTY WHITE #077

Laboratory Demographics

  • CLIA Code: 16D2089573
  • Facility Name: THRIFTY WHITE #077
  • Facility Address: 127 N MAIN STREET PO BOX 517
    PAULLINA, IA
    ZIP 51046
  • Facility Phone: 712 949-3490
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RYLEE GOOSEN
  • NPI Number: 1801228556
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D2089573
LAB Type Pharmacy
Facility Name THRIFTY WHITE #077
Street 127 N MAIN STREET PO BOX 517
City PAULLINA
State IA
ZIP 51046
Phone 712 949-3490
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/5/2025
Certificate Expiration Date 1/4/2027
Facility Type Pharmacy
Lab Director RYLEE GOOSEN

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