16D2244979 CLIA NUMBER - WELLS HOMETOWN DRUG KEOSAUQUA

Laboratory Demographics

CLIA Number: 16D2244979

Facility Name: WELLS HOMETOWN DRUG KEOSAUQUA

Facility Address:
1547 BROAD ST PO BOX 10
KEOSAUQUA, IA
ZIP 52565
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Facility Phone Number: 319 293-7757

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1437825569

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	16D2244979
LAB Type	Pharmacy
Facility Name	WELLS HOMETOWN DRUG KEOSAUQUA
Street	1547 BROAD ST PO BOX 10
City	KEOSAUQUA
State	IA
ZIP	52565
Phone	319 293-7757
CertificateType	4
CertificateEffectiveDate	12/8/2023
CertificateExpirationDate	12/7/2025
FacilityType	Waiver

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