26D2153060 CLIA NUMBER - MEDICINE SHOPPE #2120

Laboratory Demographics

  • CLIA Code: 26D2153060
  • Facility Name: MEDICINE SHOPPE #2120
  • Facility Address: 2590 W OSAGE STREET
    PACIFIC, MO
    ZIP 63069
  • Facility Phone: 636 357-9777
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALEX VAYMAN
  • NPI Number: 1629578927
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2153060
LAB Type Pharmacy
Facility Name MEDICINE SHOPPE #2120
Street 2590 W OSAGE STREET
City PACIFIC
State MO
ZIP 63069
Phone 636 357-9777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2024
Certificate Expiration Date 8/21/2026
Facility Type Pharmacy
Lab Director ALEX VAYMAN

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