17D2240791 CLIA NUMBER - WALGREENS #07147

Laboratory Demographics

  • CLIA Code: 17D2240791
  • Facility Name: WALGREENS #07147
  • Facility Address: 1555 S BROADWAY ST
    WICHITA, KS
    ZIP 67211
  • Facility Phone: 316 262-5383
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KINGSLEY C. UBAH
  • NPI Number: 1215942438
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2240791
LAB Type Pharmacy
Facility Name WALGREENS #07147
Street 1555 S BROADWAY ST
City WICHITA
State KS
ZIP 67211
Phone 316 262-5383
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/22/2023
Certificate Expiration Date 10/21/2025
Facility Type Pharmacy
Lab Director KINGSLEY C. UBAH

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