53D1045556 CLIA NUMBER - OSCO PHARMACY #0065

Laboratory Demographics

  • CLIA Code: 53D1045556
  • Facility Name: OSCO PHARMACY #0065
  • Facility Address: 3355 E PERSHING BLVD
    CHEYENNE, WY
    ZIP 82001
  • Facility Phone: 307 635-1155
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAVID DEERTZ
  • NPI Number: 1043494545
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 53D1045556
LAB Type Pharmacy
Facility Name OSCO PHARMACY #0065
Street 3355 E PERSHING BLVD
City CHEYENNE
State WY
ZIP 82001
Phone 307 635-1155
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/16/2025
Certificate Expiration Date 9/15/2027
Facility Type Pharmacy
Lab Director DAVID DEERTZ

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