26D2012175 CLIA NUMBER - WALGREENS #05289

Laboratory Demographics

  • CLIA Code: 26D2012175
  • Facility Name: WALGREENS #05289
  • Facility Address: 106 N MASSEY BLVD
    NIXA, MO
    ZIP 65714
  • Facility Phone: 417 724-9568
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WILLIAM MOLENAAR
  • NPI Number: 1275548208
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2012175
LAB Type Pharmacy
Facility Name WALGREENS #05289
Street 106 N MASSEY BLVD
City NIXA
State MO
ZIP 65714
Phone 417 724-9568
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/23/2025
Certificate Expiration Date 3/22/2027
Facility Type Pharmacy
Lab Director WILLIAM MOLENAAR

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