17D2225740 CLIA NUMBER - KANSAS CVS PHARMACY, LLC DBA CVS/PHARMACY #10862

Laboratory Demographics

  • CLIA Code: 17D2225740
  • Facility Name: KANSAS CVS PHARMACY, LLC DBA CVS/PHARMACY #10862
  • Facility Address: 110 WEST MAIN ST
    GARDNER, KS
    ZIP 66030
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMUEL L. GLENNON
  • NPI Number: 1962914838
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2225740
LAB Type Pharmacy
Facility Name KANSAS CVS PHARMACY, LLC DBA CVS/PHARMACY #10862
Street 110 WEST MAIN ST
City GARDNER
State KS
ZIP 66030
Phone 866 389-2727
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2025
Certificate Expiration Date 5/23/2027
Facility Type Pharmacy
Lab Director SAMUEL L. GLENNON

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