16D2209764 CLIA NUMBER - HY-VEE PHARMACY #1417

Laboratory Demographics

  • CLIA Code: 16D2209764
  • Facility Name: HY-VEE PHARMACY #1417
  • Facility Address: 201 N FILLMORE ST
    MOUNT AYR, IA
    ZIP 50854
  • Facility Phone: 641 464-3300
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRISTEN POORE
  • NPI Number: 1972068039
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D2209764
LAB Type Pharmacy
Facility Name HY-VEE PHARMACY #1417
Street 201 N FILLMORE ST
City MOUNT AYR
State IA
ZIP 50854
Phone 641 464-3300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/15/2025
Certificate Expiration Date 1/14/2027
Facility Type Pharmacy
Lab Director KRISTEN POORE

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