53D2075008 CLIA NUMBER - RIDLEY'S PHARMACY #1130

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Laboratory Demographics

CLIA Number: 53D2075008

Facility Name: RIDLEY'S PHARMACY #1130

Facility Address:
169 COFFEEN ST
SHERIDAN, WY
ZIP 82801
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Facility Phone Number: 307 672-1788

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1518148055

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	53D2075008
LAB Type	Pharmacy
Facility Name	RIDLEY'S PHARMACY #1130
Street	169 COFFEEN ST
City	SHERIDAN
State	WY
ZIP	82801
Phone	307 672-1788
CertificateType	4
CertificateEffectiveDate	11/14/2023
CertificateExpirationDate	11/13/2025
FacilityType	Waiver

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