53D2075006 CLIA NUMBER - SAFEWAY PHARMACY #0467

Laboratory Demographics

  • CLIA Code: 53D2075006
  • Facility Name: SAFEWAY PHARMACY #0467
  • Facility Address: 1900 E RICHARDS ST
    DOUGLAS, WY
    ZIP 82633
  • Facility Phone: 307 358-1706
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAVID HOLM
  • NPI Number: 1801825849
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 53D2075006
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0467
Street 1900 E RICHARDS ST
City DOUGLAS
State WY
ZIP 82633
Phone 307 358-1706
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2024
Certificate Expiration Date 6/8/2026
Facility Type Pharmacy
Lab Director DAVID HOLM

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