53D2110354 CLIA NUMBER - KING SOOPERS PHARMACY #79

Laboratory Demographics

  • CLIA Code: 53D2110354
  • Facility Name: KING SOOPERS PHARMACY #79
  • Facility Address: 3702 DELL RANGE BLVD
    CHEYENNE, WY
    ZIP 82001
  • Facility Phone: 307 638-0192
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIMBERLY WARD
  • NPI Number: 1962438150
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 53D2110354
LAB Type Pharmacy
Facility Name KING SOOPERS PHARMACY #79
Street 3702 DELL RANGE BLVD
City CHEYENNE
State WY
ZIP 82001
Phone 307 638-0192
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2024
Certificate Expiration Date 3/13/2026
Facility Type Pharmacy
Lab Director KIMBERLY WARD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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