17D2182340 CLIA NUMBER - PRICE CHOPPER PHARMACY #12

Laboratory Demographics

  • CLIA Code: 17D2182340
  • Facility Name: PRICE CHOPPER PHARMACY #12
  • Facility Address: 4950 ROE BLVD
    ROELAND PARK, KS
    ZIP 66205
  • Facility Phone: 913 236-2879
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL T. HALLIWELL
  • NPI Number: 1538274634
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2182340
LAB Type Pharmacy
Facility Name PRICE CHOPPER PHARMACY #12
Street 4950 ROE BLVD
City ROELAND PARK
State KS
ZIP 66205
Phone 913 236-2879
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2024
Certificate Expiration Date 4/19/2026
Facility Type Pharmacy
Lab Director MICHAEL T. HALLIWELL

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