26D2189042 CLIA NUMBER - SIKESTON MEDICENTER PHARMACY

Laboratory Demographics

CLIA Number: 26D2189042

Facility Name: SIKESTON MEDICENTER PHARMACY

Facility Address:
507 N MAIN STREET
SIKESTON, MO
ZIP 63801
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Facility Phone Number: 573 471-4401

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1316614001

Taxonomy: 3336L0003X - Pharmacy
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

CLIA Record

Field Name	Field Value
CLIA Number	26D2189042
LAB Type	Pharmacy
Facility Name	SIKESTON MEDICENTER PHARMACY
Street	507 N MAIN STREET
City	SIKESTON
State	MO
ZIP	63801
Phone	573 471-4401
CertificateType	4
CertificateEffectiveDate	7/24/2022
CertificateExpirationDate	7/23/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024