16D2127189 CLIA NUMBER - THRIFTY WHITE PHARMACY #076

Laboratory Demographics

  • CLIA Code: 16D2127189
  • Facility Name: THRIFTY WHITE PHARMACY #076
  • Facility Address: 702 MONTGOMERY STREET
    DECORAH, IA
    ZIP 52101
  • Facility Phone: 563 382-8765
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DIEGO CUEVAS
  • NPI Number: 1871934679
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D2127189
LAB Type Pharmacy
Facility Name THRIFTY WHITE PHARMACY #076
Street 702 MONTGOMERY STREET
City DECORAH
State IA
ZIP 52101
Phone 563 382-8765
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/10/2025
Certificate Expiration Date 3/9/2027
Facility Type Pharmacy
Lab Director DIEGO CUEVAS

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