26D2187889 CLIA NUMBER - MEDICENTER PHARMACY

Laboratory Demographics

  • CLIA Code: 26D2187889
  • Facility Name: MEDICENTER PHARMACY
  • Facility Address: 1474 N BOONVILLE
    SPRINGFIELD, MO
    ZIP 65802
  • Facility Phone: 417 869-1866
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TODD M. CODEMO
  • NPI Number: 1013089804
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2187889
LAB Type Pharmacy
Facility Name MEDICENTER PHARMACY
Street 1474 N BOONVILLE
City SPRINGFIELD
State MO
ZIP 65802
Phone 417 869-1866
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2024
Certificate Expiration Date 7/8/2026
Facility Type Pharmacy
Lab Director TODD M. CODEMO

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