37D2077917 CLIA NUMBER - KICKAPOO/IHS HEALTH CENTER PHARMACY

Laboratory Demographics

  • CLIA Code: 37D2077917
  • Facility Name: KICKAPOO/IHS HEALTH CENTER PHARMACY
  • Facility Address: 105365 S HWY 102
    MCLOUD, OK
    ZIP 74851
  • Facility Phone: 405 964-2081
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LISA LAUDERDALE
  • NPI Number: 1265518203
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 37D2077917
LAB Type Pharmacy
Facility Name KICKAPOO/IHS HEALTH CENTER PHARMACY
Street 105365 S HWY 102
City MCLOUD
State OK
ZIP 74851
Phone 405 964-2081
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2024
Certificate Expiration Date 5/18/2026
Facility Type Pharmacy
Lab Director LISA LAUDERDALE

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