17D2200507 CLIA NUMBER - THE MEDICINE STORE

Laboratory Demographics

  • CLIA Code: 17D2200507
  • Facility Name: THE MEDICINE STORE
  • Facility Address: 15415 PINEHURST DRIVE
    BASEHOR, KS
    ZIP 66007
  • Facility Phone: 913 724-3666
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HOLLY L. GRIPKA
  • NPI Number: 1073764973
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2200507
LAB Type Pharmacy
Facility Name THE MEDICINE STORE
Street 15415 PINEHURST DRIVE
City BASEHOR
State KS
ZIP 66007
Phone 913 724-3666
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2024
Certificate Expiration Date 11/15/2026
Facility Type Pharmacy
Lab Director HOLLY L. GRIPKA

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