17D2011269 CLIA NUMBER - WALGREENS #04665

Laboratory Demographics

  • CLIA Code: 17D2011269
  • Facility Name: WALGREENS #04665
  • Facility Address: 13450 S BLACKBOB ROAD
    OLATHE, KS
    ZIP 66062
  • Facility Phone: 913 829-3176
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MORGAN SHORT
  • NPI Number: 1780699900
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2011269
LAB Type Pharmacy
Facility Name WALGREENS #04665
Street 13450 S BLACKBOB ROAD
City OLATHE
State KS
ZIP 66062
Phone 913 829-3176
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/22/2025
Certificate Expiration Date 4/21/2027
Facility Type Pharmacy
Lab Director MORGAN SHORT

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