28D1007551 CLIA NUMBER - HY-VEE PHARMACY (1620)

Laboratory Demographics

  • CLIA Code: 28D1007551
  • Facility Name: HY-VEE PHARMACY (1620)
  • Facility Address: 2501 CORNHUSKER DRIVE
    SOUTH SIOUX CITY, NE
    ZIP 68776
  • Facility Phone: 402 494-3021
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICHOLAS OLUND
  • NPI Number: 1083650964
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 28D1007551
LAB Type Pharmacy
Facility Name HY-VEE PHARMACY (1620)
Street 2501 CORNHUSKER DRIVE
City SOUTH SIOUX CITY
State NE
ZIP 68776
Phone 402 494-3021
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2024
Certificate Expiration Date 12/19/2026
Facility Type Pharmacy
Lab Director NICHOLAS OLUND

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