17D2329834 CLIA NUMBER - MEDICAL PHARMACY, PA

Laboratory Demographics

  • CLIA Code: 17D2329834
  • Facility Name: MEDICAL PHARMACY, PA
  • Facility Address: 1100 COLUMBINE DRIVE, SUITE A
    HOLTON, KS
    ZIP 66436
  • Facility Phone: 785 364-2114
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFF R. TOBAEE
  • NPI Number: 1073325700
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2329834
LAB Type Pharmacy
Facility Name MEDICAL PHARMACY, PA
Street 1100 COLUMBINE DRIVE, SUITE A
City HOLTON
State KS
ZIP 66436
Phone 785 364-2114
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2025
Certificate Expiration Date 9/4/2027
Facility Type Pharmacy
Lab Director JEFF R. TOBAEE

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