17D1077690 CLIA NUMBER - HYVEE PHARMACY #2 (1464)

Laboratory Demographics

  • CLIA Code: 17D1077690
  • Facility Name: HYVEE PHARMACY #2 (1464)
  • Facility Address: 18101 WEST 119TH STREET
    OLATHE, KS
    ZIP 66061
  • Facility Phone: 515 559-5708
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CONRAD WAGNER
  • NPI Number: 1841218864
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D1077690
LAB Type Pharmacy
Facility Name HYVEE PHARMACY #2 (1464)
Street 18101 WEST 119TH STREET
City OLATHE
State KS
ZIP 66061
Phone 515 559-5708
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2023
Certificate Expiration Date 12/16/2025
Facility Type Pharmacy
Lab Director CONRAD WAGNER

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