52D1107152 CLIA NUMBER - HY-VEE PHARMACY 1391

Laboratory Demographics

  • CLIA Code: 52D1107152
  • Facility Name: HY-VEE PHARMACY 1391
  • Facility Address: 3801 E WASHINGTON AVE
    MADISON, WI
    ZIP 53704
  • Facility Phone: 608 244-4991
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMIR KHARBUSH
  • NPI Number: 1801028030
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D1107152
LAB Type Pharmacy
Facility Name HY-VEE PHARMACY 1391
Street 3801 E WASHINGTON AVE
City MADISON
State WI
ZIP 53704
Phone 608 244-4991
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Pharmacy
Lab Director SAMIR KHARBUSH

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This page was last updated on: 6/4/2025