16D2040343 CLIA NUMBER - WALGREENS #12148

Laboratory Demographics

  • CLIA Code: 16D2040343
  • Facility Name: WALGREENS #12148
  • Facility Address: 320 W BREMER AVENUE
    WAVERLY, IA
    ZIP 50677
  • Facility Phone: 319 596-1085
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LANCE M. GOLLY
  • NPI Number: 1215164157
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D2040343
LAB Type Pharmacy
Facility Name WALGREENS #12148
Street 320 W BREMER AVENUE
City WAVERLY
State IA
ZIP 50677
Phone 319 596-1085
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2025
Certificate Expiration Date 7/11/2027
Facility Type Pharmacy
Lab Director LANCE M. GOLLY

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