26D2214267 CLIA NUMBER - BROADWAY LTC, LLC (DBA - BROADWAY LTC PHARMACY)

Laboratory Demographics

  • CLIA Code: 26D2214267
  • Facility Name: BROADWAY LTC, LLC (DBA - BROADWAY LTC PHARMACY)
  • Facility Address: 37 DOCTORS PARK STE 7
    CAPE GIRARDEAU, MO
    ZIP 63703
  • Facility Phone: 573 803-2040
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN WOOD
  • NPI Number: 1457758153
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2214267
LAB Type Pharmacy
Facility Name BROADWAY LTC, LLC (DBA - BROADWAY LTC PHARMACY)
Street 37 DOCTORS PARK STE 7
City CAPE GIRARDEAU
State MO
ZIP 63703
Phone 573 803-2040
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2025
Certificate Expiration Date 2/21/2027
Facility Type Pharmacy
Lab Director KEVIN WOOD

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