16D2012308 CLIA NUMBER - WALGREENS #04405

Laboratory Demographics

  • CLIA Code: 16D2012308
  • Facility Name: WALGREENS #04405
  • Facility Address: 2508 WEST BROADWAY
    COUNCIL BLUFFS, IA
    ZIP 51501
  • Facility Phone: 712 328-2266
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALYSSA D. PIERSON
  • NPI Number: 1720093032
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D2012308
LAB Type Pharmacy
Facility Name WALGREENS #04405
Street 2508 WEST BROADWAY
City COUNCIL BLUFFS
State IA
ZIP 51501
Phone 712 328-2266
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Pharmacy
Lab Director ALYSSA D. PIERSON

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