53D2279578 CLIA NUMBER - ALBERTSONS PHARMACY #3435

Laboratory Demographics

  • CLIA Code: 53D2279578
  • Facility Name: ALBERTSONS PHARMACY #3435
  • Facility Address: 1005 W COULTER AVE
    POWELL, WY
    ZIP 82435
  • Facility Phone: 307 271-3160
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JILL SANDE
  • NPI Number: 1073235222
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 53D2279578
LAB Type Pharmacy
Facility Name ALBERTSONS PHARMACY #3435
Street 1005 W COULTER AVE
City POWELL
State WY
ZIP 82435
Phone 307 271-3160
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/4/2025
Certificate Expiration Date 4/3/2027
Facility Type Pharmacy
Lab Director JILL SANDE

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