53D0695214 CLIA NUMBER - ADMIRAL BEVERAGE CORP MED CLINIC

Laboratory Demographics

  • CLIA Code: 53D0695214
  • Facility Name: ADMIRAL BEVERAGE CORP MED CLINIC
  • Facility Address: 709 ROBERTSON AVENUE
    WORLAND, WY
    ZIP 82401
  • Facility Phone: 307 347-4201
  • Facility Type: Industrial
  • Facility Type: Waiver
  • Lab Director: C B. JOHNS
  • NPI Number: 1538204375
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 53D0695214
LAB Type Industrial
Facility Name ADMIRAL BEVERAGE CORP MED CLINIC
Street 709 ROBERTSON AVENUE
City WORLAND
State WY
ZIP 82401
Phone 307 347-4201
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Industrial
Lab Director C B. JOHNS

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