53D2298474 CLIA NUMBER - BROULIMS PHARMACY #4 - THAYNE

Laboratory Demographics

  • CLIA Code: 53D2298474
  • Facility Name: BROULIMS PHARMACY #4 - THAYNE
  • Facility Address: 118 PETERSEN PKWY
    THAYNE, WY
    ZIP 83127
  • Facility Phone: 307 883-6337
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARCUS C. HURST
  • NPI Number: 1225478894
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 53D2298474
LAB Type Pharmacy
Facility Name BROULIMS PHARMACY #4 - THAYNE
Street 118 PETERSEN PKWY
City THAYNE
State WY
ZIP 83127
Phone 307 883-6337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/2/2024
Certificate Expiration Date 2/1/2026
Facility Type Pharmacy
Lab Director MARCUS C. HURST

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