43D2290831 CLIA NUMBER - BLOSSOM KETAMINE INFUSIONS PLLC

Laboratory Demographics

  • CLIA Code: 43D2290831
  • Facility Name: BLOSSOM KETAMINE INFUSIONS PLLC
  • Facility Address: 1760 RAND RD
    RAPID CITY, SD
    ZIP 57702
  • Facility Phone: 605 593-0560
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: JEN LEVY
  • NPI Number: 1528043809
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 43D2290831
LAB Type Independent
Facility Name BLOSSOM KETAMINE INFUSIONS PLLC
Street 1760 RAND RD
City RAPID CITY
State SD
ZIP 57702
Phone 605 593-0560
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2025
Certificate Expiration Date 10/1/2027
Facility Type Independent
Lab Director JEN LEVY

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