53D2141014 CLIA NUMBER - BROULIMS PHARMACY #12-AFTON

Laboratory Demographics

  • CLIA Code: 53D2141014
  • Facility Name: BROULIMS PHARMACY #12-AFTON
  • Facility Address: 141 WASHINGTON ST
    AFTON, WY
    ZIP 83110
  • Facility Phone: 307 885-5550
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARCUS C. HURST
  • NPI Number: 1659615078
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 53D2141014
LAB Type Pharmacy
Facility Name BROULIMS PHARMACY #12-AFTON
Street 141 WASHINGTON ST
City AFTON
State WY
ZIP 83110
Phone 307 885-5550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/2/2024
Certificate Expiration Date 2/1/2026
Facility Type Pharmacy
Lab Director MARCUS C. HURST

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