17D2011834 CLIA NUMBER - WALGREENS #05793

Laboratory Demographics

  • CLIA Code: 17D2011834
  • Facility Name: WALGREENS #05793
  • Facility Address: 710 N WEST STREET
    WICHITA, KS
    ZIP 67203
  • Facility Phone: 316 943-2299
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PATRICK R. CHANEY
  • NPI Number: 1508871724
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2011834
LAB Type Pharmacy
Facility Name WALGREENS #05793
Street 710 N WEST STREET
City WICHITA
State KS
ZIP 67203
Phone 316 943-2299
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2023
Certificate Expiration Date 5/12/2025
Facility Type Pharmacy
Lab Director PATRICK R. CHANEY

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This page was last updated on: 3/20/2025