17D2038582 CLIA NUMBER - WALGREENS #9049

Laboratory Demographics

  • CLIA Code: 17D2038582
  • Facility Name: WALGREENS #9049
  • Facility Address: 1911 NORTH BROADWAY STREET
    PITTSBURG, KS
    ZIP 66762
  • Facility Phone: 620 231-1486
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JORDAN DAVIED
  • NPI Number: 1588679708
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2038582
LAB Type Pharmacy
Facility Name WALGREENS #9049
Street 1911 NORTH BROADWAY STREET
City PITTSBURG
State KS
ZIP 66762
Phone 620 231-1486
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/14/2025
Certificate Expiration Date 4/13/2027
Facility Type Pharmacy
Lab Director JORDAN DAVIED

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