17D1088398 CLIA NUMBER - WALGREENS #4185

Laboratory Demographics

  • CLIA Code: 17D1088398
  • Facility Name: WALGREENS #4185
  • Facility Address: 4951 ROE BOULEVARD
    ROELAND PARK, KS
    ZIP 66205
  • Facility Phone: 913 236-6978
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRISTA D. MILLIS
  • NPI Number: 1235144452
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D1088398
LAB Type Pharmacy
Facility Name WALGREENS #4185
Street 4951 ROE BOULEVARD
City ROELAND PARK
State KS
ZIP 66205
Phone 913 236-6978
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2025
Certificate Expiration Date 8/16/2027
Facility Type Pharmacy
Lab Director TRISTA D. MILLIS

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