17D2183323 CLIA NUMBER - FOUR STATES PHARMACY

Laboratory Demographics

  • CLIA Code: 17D2183323
  • Facility Name: FOUR STATES PHARMACY
  • Facility Address: 1605 HWY K 66, STE B
    GALENA, KS
    ZIP 66739
  • Facility Phone: 620 783-1636
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: MARK S. MAYBERRY
  • NPI Number: 1992078117
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2183323
LAB Type Independent
Facility Name FOUR STATES PHARMACY
Street 1605 HWY K 66, STE B
City GALENA
State KS
ZIP 66739
Phone 620 783-1636
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/4/2024
Certificate Expiration Date 5/3/2026
Facility Type Independent
Lab Director MARK S. MAYBERRY

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