16D2188196 CLIA NUMBER - HY-VEE PHARMACY #1 - 1105

Laboratory Demographics

CLIA Number: 16D2188196

Facility Name: HY-VEE PHARMACY #1 - 1105

Facility Address:
3019 ROCKINGHAM ROAD
DAVENPORT, IA
ZIP 52802
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Facility Phone Number: 563 322-7573

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1992731160

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	16D2188196
LAB Type	Pharmacy
Facility Name	HY-VEE PHARMACY #1 - 1105
Street	3019 ROCKINGHAM ROAD
City	DAVENPORT
State	IA
ZIP	52802
Phone	563 322-7573
CertificateType	4
CertificateEffectiveDate	7/14/2022
CertificateExpirationDate	7/13/2024
FacilityType	Waiver

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