53D0952972 CLIA NUMBER - STATE OF WYOMING WIC PROGRAM

Laboratory Demographics

CLIA Number: 53D0952972

Facility Name: STATE OF WYOMING WIC PROGRAM

Facility Address:
122 W 25TH ST, 3RD FL WEST
CHEYENNE, WY
ZIP 82009
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Facility Phone Number: 307 777-6009

Facility Type: Public Health Laboratories

Certificate Type: Waiver

NPI Number: 1366634396

Taxonomy: 251K00000X - Public Health or Welfare

CLIA Record

Field Name	Field Value
CLIA Number	53D0952972
LAB Type	Public Health Laboratories
Facility Name	STATE OF WYOMING WIC PROGRAM
Street	122 W 25TH ST, 3RD FL WEST
City	CHEYENNE
State	WY
ZIP	82009
Phone	307 777-6009
CertificateType	4
CertificateEffectiveDate	10/22/2022
CertificateExpirationDate	10/21/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024