26D2053807 CLIA NUMBER - WALGREENS #12628

Laboratory Demographics

  • CLIA Code: 26D2053807
  • Facility Name: WALGREENS #12628
  • Facility Address: 2001 S RANGE LINE RD
    JOPLIN, MO
    ZIP 64804
  • Facility Phone: 417 626-8553
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC T. BRESEE
  • NPI Number: 1053640441
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2053807
LAB Type Pharmacy
Facility Name WALGREENS #12628
Street 2001 S RANGE LINE RD
City JOPLIN
State MO
ZIP 64804
Phone 417 626-8553
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2025
Certificate Expiration Date 4/11/2027
Facility Type Pharmacy
Lab Director ERIC T. BRESEE

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