53D2203563 CLIA NUMBER - POLE MOUNTAIN PHARMACY

Laboratory Demographics

  • CLIA Code: 53D2203563
  • Facility Name: POLE MOUNTAIN PHARMACY
  • Facility Address: 319 E HARNEY STREET
    LARAMIE, WY
    ZIP 82072
  • Facility Phone: 307 460-4080
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRETT KVENLID
  • NPI Number: 1013422971
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 53D2203563
LAB Type Pharmacy
Facility Name POLE MOUNTAIN PHARMACY
Street 319 E HARNEY STREET
City LARAMIE
State WY
ZIP 82072
Phone 307 460-4080
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/4/2024
Certificate Expiration Date 12/3/2026
Facility Type Pharmacy
Lab Director BRETT KVENLID

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