53D2176754 CLIA NUMBER - COALITION FAMILY PHARMACY

Laboratory Demographics

CLIA Number: 53D2176754

Facility Name: COALITION FAMILY PHARMACY

Facility Address:
430 S MEDICAL ARTS CT
GILLETTE, WY
ZIP 82716
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Facility Phone Number: 307 686-3835

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1144497603

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	53D2176754
LAB Type	Pharmacy
Facility Name	COALITION FAMILY PHARMACY
Street	430 S MEDICAL ARTS CT
City	GILLETTE
State	WY
ZIP	82716
Phone	307 686-3835
CertificateType	4
CertificateEffectiveDate	12/23/2023
CertificateExpirationDate	12/22/2025
FacilityType	Waiver

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