17D2011842 CLIA NUMBER - WALGREENS #06362

Laboratory Demographics

  • CLIA Code: 17D2011842
  • Facility Name: WALGREENS #06362
  • Facility Address: 333 WEST 13TH STREET NORTH
    WICHITA, KS
    ZIP 67203
  • Facility Phone: 316 264-6189
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAY W. MOUNKES
  • NPI Number: 1508872144
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2011842
LAB Type Pharmacy
Facility Name WALGREENS #06362
Street 333 WEST 13TH STREET NORTH
City WICHITA
State KS
ZIP 67203
Phone 316 264-6189
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2025
Certificate Expiration Date 5/12/2027
Facility Type Pharmacy
Lab Director JAY W. MOUNKES

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