17D2176434 CLIA NUMBER - CLARK PHARMACY

Laboratory Demographics

  • CLIA Code: 17D2176434
  • Facility Name: CLARK PHARMACY
  • Facility Address: 104 S MAIN
    CIMARRON, KS
    ZIP 67835
  • Facility Phone: 620 855-2242
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW D. MONICAL
  • NPI Number: 1720145105
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2176434
LAB Type Pharmacy
Facility Name CLARK PHARMACY
Street 104 S MAIN
City CIMARRON
State KS
ZIP 67835
Phone 620 855-2242
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2023
Certificate Expiration Date 12/12/2025
Facility Type Pharmacy
Lab Director MATTHEW D. MONICAL

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