53D2141014 CLIA NUMBER - BROULIMS PHARMACY #12-AFTON

Laboratory Demographics

CLIA Number: 53D2141014

Facility Name: BROULIMS PHARMACY #12-AFTON

Facility Address:
141 WASHINGTON ST
AFTON, WY
ZIP 83110
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Facility Phone Number: 307 885-5550

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1659615078

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	53D2141014
LAB Type	Pharmacy
Facility Name	BROULIMS PHARMACY #12-AFTON
Street	141 WASHINGTON ST
City	AFTON
State	WY
ZIP	83110
Phone	307 885-5550
CertificateType	4
CertificateEffectiveDate	2/2/2024
CertificateExpirationDate	2/1/2026
FacilityType	Waiver

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