26D2012531 CLIA NUMBER - WALGREENS #04466

Laboratory Demographics

  • CLIA Code: 26D2012531
  • Facility Name: WALGREENS #04466
  • Facility Address: 3645 FREDERICK AVE
    SAINT JOSEPH, MO
    ZIP 64506
  • Facility Phone: 816 232-5342
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MINDY PAVLICH
  • NPI Number: 1619982634
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2012531
LAB Type Pharmacy
Facility Name WALGREENS #04466
Street 3645 FREDERICK AVE
City SAINT JOSEPH
State MO
ZIP 64506
Phone 816 232-5342
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Pharmacy
Lab Director MINDY PAVLICH

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