17D2020474 CLIA NUMBER - WALGREENS #11924

Laboratory Demographics

  • CLIA Code: 17D2020474
  • Facility Name: WALGREENS #11924
  • Facility Address: 11830 WEST 75TH STREET
    SHAWNEE, KS
    ZIP 66214
  • Facility Phone: 913 433-2359
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHANNON S. FAGER
  • NPI Number: 1023248713
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2020474
LAB Type Pharmacy
Facility Name WALGREENS #11924
Street 11830 WEST 75TH STREET
City SHAWNEE
State KS
ZIP 66214
Phone 913 433-2359
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2025
Certificate Expiration Date 7/13/2027
Facility Type Pharmacy
Lab Director SHANNON S. FAGER

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