26D2105943 CLIA NUMBER - COUNTRY MART PHARMACY #73

Laboratory Demographics

  • CLIA Code: 26D2105943
  • Facility Name: COUNTRY MART PHARMACY #73
  • Facility Address: 15720 US HWY 160
    FORSYTH, MO
    ZIP 65653
  • Facility Phone: 417 829-9281
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROGER HILBURN
  • NPI Number: 1861721227
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2105943
LAB Type Pharmacy
Facility Name COUNTRY MART PHARMACY #73
Street 15720 US HWY 160
City FORSYTH
State MO
ZIP 65653
Phone 417 829-9281
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2023
Certificate Expiration Date 12/7/2025
Facility Type Pharmacy
Lab Director ROGER HILBURN

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