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53D2231639 CLIA NUMBER - WALGREENS #12378

Laboratory Demographics

CLIA Number: 53D2231639

Facility Name: WALGREENS #12378

Facility Address:
1585 SHERIDAN AVE
CODY, WY
ZIP 82414
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Facility Phone Number: 307 587-2017

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1538398904

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 53D2231639
LAB Type Pharmacy
Facility Name WALGREENS #12378
Street 1585 SHERIDAN AVE
City CODY
State WY
ZIP 82414
Phone 307 587-2017
CertificateType 4
CertificateEffectiveDate 8/4/2023
CertificateExpirationDate 8/3/2025
FacilityType Waiver

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