17D2062554 CLIA NUMBER - WALGREENS #12923

Laboratory Demographics

  • CLIA Code: 17D2062554
  • Facility Name: WALGREENS #12923
  • Facility Address: 2900 SOUTH 4TH STREET
    LEAVENWORTH, KS
    ZIP 66048
  • Facility Phone: 913 651-2027
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SILAS MOGONDO
  • NPI Number: 1184856619
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2062554
LAB Type Pharmacy
Facility Name WALGREENS #12923
Street 2900 SOUTH 4TH STREET
City LEAVENWORTH
State KS
ZIP 66048
Phone 913 651-2027
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director SILAS MOGONDO

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